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<br /> <br />4 (Form 1 - All information for DRMS use and confidential ding) <br />5. Describe proposed surface excavation or other land disturbance, including roads, pits, trenches, waste piles, drill pads and <br />collar areas of underground workings, ponds, etc... <br />PLEASE SEE EXHIBIT C <br />6. Proposed Disturbance (approximate) Describe the proposed drilling to be conducted, including anticipated number of holes, <br />diarneter, depth, location, etc... Submit additional pages if necessary: NO CHANG E <br />A. Drill Pads: Quantity Average Width (ft) Average Length (ft) <br />B. Drill Holes: Quantity Depth (ft) Diameter (in) <br />C. Mud Pits: Quantity Average Width (ft) Average Length (ft) <br />Average Depth (ft) <br />Described proposed underground work, including reopening of old workings, advancement of adits or shafts, <br />trenches, pits, cuts, rock dumps, or other types of disturbance, describe type, quantity and general dimensions: <br />D. Other Disturbances (please describe): <br />E. Indicate Chemicals and Fuels used or stored on site. List type, quantity and method to store. <br />F. New Road(s): Length (ft) Width (ft) <br />Significantly Upgraded Road(s) Length (ft) Width (ft) <br />Are culverts or other crossings proposed? If so, please describe: