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Appendix A. <br />APPLICANT'S QUESTIONNAIRE TO THE COLORADO DIVISION OF WILDLIFE <br />For Limited Impact Operations <br />(Permit 110 -1 and 110 -2) or X Ht e <br />Regular Operations Permit 112) <br />Instructions to the applicant: Complete both sides of this form. Send the <br />completed form to the appropriate Division of Wildlife (DOW) Regional Manager. <br />Regional Managers: <br />NW Region: 711 Independent Avenue Grand Junction, CO 81505 <br />NE Region: 317 W. Prospect Avenue Ft. Collins, CO 80526 <br />Central: 6060 Broadway Denver, CO 80216 <br />SW Region: 2300 S. Townsend Avenue Montrose, CO 81401 <br />SE Region: 2126 N. Weber Colorado Springs, CO 80907 <br />To expedite processing, please provide the information in the format and order <br />described in this form. Type or print clearly. Incomplete questionnaires will be <br />returned. Please allow 30 days for processing of completed form. Your cooperation <br />is appreciated. <br />PLEASE ATTACH THE FOLLOWING INFORMATION TO THIS FORM: <br />A. Mining and Reclamation Plan: Description of proposed reclamation plan or <br />submit Mining and Reclamation Plan as prepared for MLRD application. <br />8. M���apps: Submit copies of maps for the both the Mining Plan and the Reclamation <br />Plan. Suggested maps are those prepared for the MLRD application. <br />For the 110 -1 Permit, Two Acre Limited Impact Operation: Exhibit A - Location <br />Map Exhibit C - Affected Lands Map. <br />For the 110 -2 Permit, Limited Impact Operation: Exhibit E - Mining Plan Map <br />and Reclamation Plan Map. <br />For the 112 Permit, Regular Operation: Exhibit C - Pre- Mining and Mining Plan <br />Map(s) of Affected Lands, and Exhibit F - Reclamation Plan Map. <br />1. Operation name (pit, mine): Refuge Pit (Permit #M- 89 -112) Conversion No. 1 <br />2. Application type (check one): <br />3. Name of applicant /operator: Moffat County Board of County Commissioners <br />(OVER <br />Address: 221 W. Victory Way, Craig, CO 81625 <br />Phone Number: ( 824-5517 <br />4. Name of contact person (if different from above): <br />Address: PO. Box 667, Craig, CO 81626 <br />Two Acre Limited Impact Operation (110 -1) <br />Limited Impact Operation (110 -2) <br />xx Regular Permit Operation (112) <br />Bill Mack <br />Phone Number: (970) 824 -3211 (Ext. 15) <br />5. Location of mine: Moffat, T1ON, 103W, Section 10, SW1 /4SW1 /4 <br />(County, Township, Range, Section to nearest quarter quarter) <br />-10- <br />