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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />CHECK ONE: <br />FORM 2 (Public File) <br />NOTICE OF INTENT TO CONDUCT PROSPECTING OPERATIONS <br />FOR HARD ROCK/METAL MINES <br />1 <br />NOI# <br />I. GENERAL INFORMATION <br />1. DATE NOI RECEIVED BY THE DIVISION: (office use only) <br />2. PROJECT NAME: tell ( /t- <br />8. PROSPECTOR: PERSON MLRB SHOULD CONTACT: <br />Name: 8 c a ;t� t�L�j s"" _ ` 6 Name: <br />Title: / �y �,,� Title: <br />Company Name: iVi v "�/, dl I C Company Name: <br />Street: 1 f /$3 /L°.W 4 Street: <br />P.O. Box: ‘7 P.O. Box: <br />City: � ! Pt�°,� " City: <br />State: State: <br />Zip Code: g© Zip Code: <br />Telephone Number: 2 ' e % f d)J k.../ Telephone Number: <br />3) Fax Number: . Fax Number: <br />9. APPLICATION FEE: $86. (NOIs and modifications require an $86 fee which must accompany this notice or it cannot be <br />processed by the Division). <br />10. LOCATION INFORMATION: <br />County: ,ciA <br />PRINCIPAL MER(check one) <br />SECTION (write number): <br />Office of <br />Mined Land Reclamation <br />S <br />There is an NOI Number Already Assigned to this Operation <br />P- - (Please reference the file number assigned to this operation) <br />New NOI <br />Modification to an Existing NOI <br />P- - (Provide for Modifications to an existing NOI) <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />6 (Colorado <br />P- 2oi1 - 0/7 <br />STATE OF COLORADO <br />RECEIVED <br />JUN 2 8 2011 <br />Division or Reclamation, <br />Mining and Safety <br />10" (New Mexico <br />TOWNSHIP (write number and check direction) T Z North J South <br />(Ute) <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />