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STATE OF COLORADO <br />DIVISION Of RECLAMATION, MINING AND SAFETY <br />Department of Na ural Resnurres <br />1313 Shaman S}.. Rnom > 1.' <br />Denver. Colorado 80203 <br />phone; r.3931 6b(, -336 <br />TAX: 1303, 8 3 } -S i(k <br />MINERAL PROSPECTING DRILL HOLE <br />PERMANENT ABANDPAMN "I' FINAL REPORT <br />COLORADO <br />DIVr$1c1N CfE <br />RECLAMATION <br />MINING <br />SAFETY <br />Pursuant to the terms of 34- 32- 113(5.5)(d) and (e) of the Act, all information provided in this report shall be protected <br />as confidential information by the Mined Land Reclamation Board and shall never be a matter of public record. <br />Prospect Site Name: <br />Drill I tole I.D. No. <br />Date Drilled: <br />OPERATOR: (PROSPECTOR) <br />Name: <br />Address: <br />City: _-__ <br />Telephone No.: <br />St.: Zip :_ <br />Prospect NOI No.: P -- <br />Date Permanently Abandoned: <br />DRILLER: <br />Name: <br />Address: <br />City: St. Zip: <br />Telephone No.: ( ) <br />LOCATION: <br />The following information is rewired for all prospecting drill holes: <br />-- <br />1/4 of the _ 1/4 of Section _ _ Township ,,,,,_ , Range <br />Prime Meridian, <br />If the area has not been surveyed, supply the Longitude ..-....-_,___._-. West and Latitude _ _ North. <br />or attach a location map, preferably a USGS Quad. <br />flie following additional information is required for artesian flow ing holes: <br />Distances must bu provided ►with an accttrac of t200 lest (14-32-113(5.5)(d)) feet north south from the south onorth section line <br />feet east ❑west from then wesrl east section line <br />I�QTI:: In the case of closely spaced drill holes having similar geologic and hydrologic characteristics, the Operator <br />mayf, with the approval of the Division, submit a Single consolidated final report including the location of all <br />drill holes and a description of abandonment technique. In such a case, complete 9A abandonment final <br />report fortis and attach a list of drill hole locations. If more space is needed to provide any of the <br />information loo this Corm, please attach separate shcets. <br />t.rii,: a o: 011K n1 <br />N -1ru d t.=fx1 ke lorn.woi fi+ reL :K Caxid luwii m • Durango eoa Martnre "rr.�, <br />