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r ~'- ~ ~y III IIIIIIIIIIIIIIII j QED -~~ . ;~, RE~E1 APR 2 41987 LIMITED IMPACT OPERATION (110) MINEDIAND APPLICATION FORM tiECLAMASION DWISI~N This form contains two major parts: (1) General Operation Information and (2) Exhibits A-G. When you submit your application, be sure to include two si~~ne~~d copies of the General Operation Information, two copies of Exhibits A-G, and as check for the application fee described under (4) below. To expedite processing, please provide the information in the format and order described in this form.~_~2_~a_- SAS r?~_C~53Ff GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. ----------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- 1. Applicant/Operator Name: Stanle~ J. Conner 2. Operation Name (Pit, mine or site name): T Pe NC. ~ Facer 3. Application type: Limited Impact Operation (110). q lesg -fc,v„ I, O JJ 4. Application Fee for Permitted Acreage* ~9-~?fT- permitted acres. ($10 x (affected acres) + S25.D0).* Nate pe~rnitted acreage and application fee and attach ,r check for this amount when you file. ,~ ~~ application fee. 5. Substanc:e(s) to be mined (e. g., gold/silver/gravel): Gold 6. Owners(:;) of Substance to be Mined (cheek applicable box(s)1: ^ Private ^ State ~ Federal ^ Indian 7. Owners; of Record of Affected Land (check applicable box(s)): ^ Private ^ State ~1 Federal ^ Indian 8. Type of dining Operation (check applicable box(s)): a Surface ^ Underground ^ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: Gil yin PRIhlCIPLE MERIDIAN check one 5th (Colorado) ^ 10th (New hiexico)^ Ute TOWNSHIP (write number and check i ection): T ^ iJorth ~7 South RANGE (write number and check direction): R _~- ^ East Q West SECTION (write number): 5 ~~~ QUARTER SECTION (check one): ^~~ ® NW ^ SE ^ SW QUARTER/QUARTER SECTION (check one): ^ NE ^ NW X~ SE ^ SW GEN=RAL DESCRIPTION: (mi'les and direction ~ ~,;lPC SE of central city from nearest town and approximate elevation) * If the operato:^ is a unit of State or county government, an application fee is not required. A i`raction of an acre must be counted as one acre for fee calculation.