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— 2 — Mk-5/c ,2J. /114.61c 6. Name of owner of the subsurface rights of affected land: 7. Name of owner of the surface of affected land: 8. Type of mining operation: 7 >(,_ Surface Underground 1n -situ 9. Location Information: The center of the area where the majority of mining will occur: PRINCIPAL MERIDIAN (check one): SECTION (write number): TOWNSHIP (write number and check direction): RANGE (write number and check direction): QUARTER SECTION (check one): QUARTER/QUARTER SECTION (check one): 10. Primary future (Post - mining) land use (check one): Cropland(CR) Rangeland(RL) R dential(RS) J Developed Water Resources(WR) 11. Primary present land use (check one): 1and(CR) Rangeland(RL) _ Residential(RS) Developed Water Resources (WR) 13. Description of Amendment or Conversion: COUNTY: 6th (Colorado) S< V North R �_ East 10th (New Mexico) Ute South 1. West NE NW SE V SW NE NW f/ SE SW GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): is iWii e 5txrat of ? (a evil f �O -- 162 �L � y RA I Pastureland(PL) Forestry(FR) Recreation(RC) Pastureland(PL) Forestry(FR) Recreation(RC) General Agriculture(GA) ✓ Wildlife Habitat(WL) C S cc. IndustrialiCommercial(IC) _ Solid Waste Disposal(WD) General Agriculture(GA) Wildlife Habitat(WL) _ IndustriallCommercial(IC) Mining (MN) If you are amending or cones' g n existing operation, provide a brief narrative describing the proposed change(s): 12. If this operation will use designated chemicals, or will result, or presently has acid mine drainage - you Qum use this application form. You must submit either a 110d or 112d application form for Designated Mining Operations. In either case, you must list any acidic or toxic - forming materials, ... osed or disturbed as a result of the mining operation, and whether the operation will result in or esse has acid mine drainage: JAL" 1n �✓/L- - Ah r '- C f eruct -� I CJXI L Rom yU6--