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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resource <br />1313 Sherman 53., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />STATE OF COLORADO <br />M.INERA.L PROSPECTING DRILL HOLE <br />PERMANENT ABANDONMENT FINAL REPORT <br />COLORADO <br />O I v 1 S 1 O I. OF <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />Pursuant to the terms of 34-32-113(5.5)(d) and (e) of the Act, all information provided in this report shall be protected <br />as confidential information by the Mined Land Reclamation Board and shall never be a matter of public record. <br />Prospect Site Name: Prospect NOI No.: P- <br />Drill Hole I.D. No. <br />Date Drilled: Date Permanently Abandoned: <br />OPERATOR: (PROSPECTOR) DRILLER: <br />Name: Name: <br />Address: Address: <br />City: St.: Zip: City: St.: Zip: <br />Telephone No.: L_ ) Telephone No.: ( ) <br />LOCATION: <br />The following information is required for all prospecting drill holes: <br />1/4 of the 1/4 of Section , Township <br />Prime Meridian, County. <br />The following additional information is required for artesian flowing holes: <br />0111c of <br />Mined Land Rey <br />If the area has not been surveyed, supply the Longitude <br />or attach a location map. preferably a 1.)SGS Quad. <br />Distances must be rovided with an accurac of 3200 feet (34- 32- 113(5.5)(d)) <br />feetrtorth south from the so north section line <br />feet east riwest from thel I west east section line <br />, Range <br />West and Latitude North. <br />NOTE: In the case of closely spaced drill holes having similar geologic and hydrologic characteristics, the Operator <br />may, with the approval of the Division. submit a single consolidated final report including the location of all <br />drill holes and a description of abandonment technique. In such a case. complete one abandonment final <br />report forth and attach a list of drill hole locations. If more space is needed to provide any of the <br />information for this form please attach separate sheets. <br />Orrice of <br />Denver d Grand Junction Durango Active ana Inactive Mine, <br />