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USDA, Forest Service <br />Submitted by: <br />Plan Received by: <br />B. Type of Operation: <br />PLAN OF OPERATIONS FOR MINING ACTIVITIES <br />ON NATIONAL FOREST SYSTEM LANDS <br />USE OF THIS FORM IS OPTIONAL! 1n TIME USERS SHOULD DIRECT QUESTIONS REGARDING THIS FORM OR <br />REGULATIONS (36 CFR 228A) TO THE FOREST SERVICE DISTRICT OFFICE NEAREST YOUR AREA OF INTEREST. <br />Signature <br />Signature <br />Signature <br />I. GENERAL INFORMATION <br />A. Name of Mine/Project: /! ' p p K - <br />placer, <br />elopment, pro• c ' other) <br />(ode <br />II. PRINCIPALS <br />A. Name, address and phone number of operator: <br />ill, exploration, <br />e <br />Title <br />C. Is this a (❑newntinuing) operation? (check one). <br />If continuing a previous operation, this plan ( ❑replaces/ ❑modifies/ ❑supplements) a previous plan of <br />operations. (check one) <br />D. Proposed start-up date (mm/dd/yy) of operation: <br />E. Expected total duration of this operation: <br />A <br />F. If seasonal, expected date (mm/dd/yy) of annual reclamation/stabilization close out: <br />C. Name, address and phone number of owners of the claims if different than <br />( the operator): <br />(If more space is needed to fill out a block of information, use additional sheets and attach form) <br />FS- 2800 -5 (Rev. 3/08) <br />OMB NO. 0596-0022 <br />Title Date <br />(mm/dd/yy) <br />Title Date <br />(mm/dd/yy) <br />Date <br />(mm/dd/yy) <br />6 rill rhy2%--- <br />G Expected date (mm/dd/yy) for completion of all required reclamation: <br />onK <br />ame, address, and phone number of authorized field presentative (if other than the operato <br />Attach authorization to act on behalf of operator. <br />