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or, "'�0 <br />"J876 ; <br />Ricnarc 0. Lamm <br />Governor <br />0'-PM; ; °%'_12 222 <br />DEPARTMENT OF NATURAL RESOURCES <br />0. Mani• Pascoe. Execuure Director <br />MINED LAND RECLAMATION DIVISION <br />DAVID C. SHELTON, 01rector <br />RECEIVED_ <br />JUL 2 5 2013 <br />DIVISION OF RE n <br />� <br />MINING MD <br />0 <br />)JUL 16 2013 <br />VVATER Rfzb E,- <br />STATE Et�DI>t�R <br />001 n <br />This report is filed in accordance with Rule 4.07.3(3) of the Regulations of <br />the Colorado Mined Land Reclamation Board for Coal Mining, adopted in <br />accordance with the Colorado Surface Coal Mining Act, C.R.S. 34 -33 -101 et se <br />This report is to be submitted within 60 days of sealing and plugging o a� <br />drill holes approved under the specific drilling program. This report can be <br />used for single or multiple holes and can be modified as needed, provided that <br />the information contained in Rule 4.07.3(3) is supplied. Additional sheets <br />may be attached, if necessary. <br />,Prospectc <br />Address: <br />Notice of Intent No. d1A County: -&U-4 <br />r <br />. - CWT <br />L � <br />L <br />Name of Drilling Contractor: <br />License of Drill and Rig: <br />(Continued on Next Page) <br />(Rev. 5/83) <br />Oac. No. 3078 <br />423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel. (303) 866 -3567 <br />