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Standard Form 424 <br /> OMB Approval No.0348-0043 <br /> APPLICATION FOR 2. DATE SUBMITTED Applicant Identifier <br /> FEDERAL ASSISTANCE August 30, 1999 <br /> 1 TYPE OF SUBMISSION 3. DATE RECEIVED BY STATE State Application Identifier <br /> Application x Preap lication <br /> [x 1 Construction []Construction F DATE RECEIVED BY FEDERAL AGENCY Federal Identifier <br /> [1 Non-Construction (]Non-Construction <br /> 5 APPLICANT INFORMATION <br /> Legal Name:Colorado Division of Minerals and Geology Organizational Unit:Office of Active and Inactive Mines <br /> Address(give city,county,state,and zip code): Name and telephone number of the person to be contacted on matters involving this <br /> application(give area code) <br /> 1313 Sherman Street <br /> Room 215 James B.McArdle (303)866-3789 <br /> Denver,Colorado 80203 <br /> 6. EMPLOYER IDENTIFICATION NUMBER(EIN): 7. TYPE OF APPLICANT(enter appropriate letter in box) [A] <br /> A. State H. Independent School District <br /> B. County I. State Controlled Institution of Higher Learning <br /> 8. TYPE OF APPLICATION: C. Municipal J. Private University <br /> [X]New [j Continuation []Revision D. Township K. Indian Tribe <br /> E. Interstate L. Individual <br /> If revision,enter appropriate letter(s)in box(es): [] [] F. Intermunicipal M. Profit Organization <br /> A. Increase Award B. Decrease Award []Increase Duration G. Special District N. Other(Specify) <br /> D. Decrease Duration Other(specify): <br /> Amendment#2 <br /> 10. CATALOG OF FEDERAL DOMESTIC 1 5 --2 5 2 9. NAME OF FEDERAL AGENCY: U.S.OFFICE OF SURFACE MINING <br /> ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br /> TITLE: Abandoned Mine Land Program Construction at Dutch Creek-Civil Penalty Funds <br /> Colorado Inactive Mine Reclamation Program <br /> 12. AREAS AFFECTED BY PROJECT(cities,counties,states,etc.) Grant Number 900081 <br /> Pitkin County <br /> 13. PROPOSED PROJECT- 14. CONGRESSIONAL DISTRICTS OF: <br /> Start Date Ending Date a. Applicant b. Project <br /> 9\1\99 1 8\31\01 First 1 2,3,4,5,6 <br /> 15. ESTIMATED FUNDING: 16. IS APPI ICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER 12372 PROCESS, <br /> a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE <br /> a. Federal $63,000.00 AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 PROCESS <br /> FOR REVIEW ON: <br /> b. Applicant <br /> C. State DATE <br /> d. Local b. NO [ 1 PROGRAM IS NOT COVERED BY E.O. 12372 <br /> e. Other [X] OR PROGRAM HAS NOT BEEN SELECTED FOR STATE <br /> REVIEW <br /> f. Program Income 17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> g. TOTAL $63,000.00 <br /> [ ] Yes If"Yes,"attach an explanation [X]No <br /> 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF.ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT,THE DOCUMENT HAS BEEN DULY <br /> AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED <br /> a. Typed Name of Authorized Representative b. Title 7(�30T)866-3567 <br /> lephone number <br /> chael B Lon Director <br /> d. Si ture f Authorized Representative e. Date igned <br /> 2/3 0 7 <br /> Previous Editions Not Usable Standard Form 424(REV 4-88) <br /> Prescribed by OMB Circular A-102 <br />