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• III IIIIIIIIIIIII III 999 ri~~( j 1. i:)yi~ LIMITED IMPACT OPE"JITION (110(2)) APPLICATION'FORM MINEU LANLi ".-^~ AMATION f)I~~" The Application for a Limited Impact Operation Reclamation Permit contains three major parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the application fee. When you submit your Application, be sure to include two si ned copies of the Application Form, two copies of Exhibits A-F, and a check for the app ica ion fee described under (4) below. To expedite processing, please provide the information in the format and order described in this form. ----------------------------- GENERAL OPERATION INFORMATION --------------------__-_------ Type or print clearly, in the space provided, all information described below. 1. Applicant/OperatorName: Connell Resources, Inc. 2. Operation Name (Pit, mine or site name): Carrmilletti Pic 3. Application type: Limited Impact Operation (110). 4. Application Fee for Permitted Acreage* permitted acres. (S10 x (affected acres) + 525.00).* Note permitted acreage and application fee and attach a check for this amount when you file. application fee. 5. Substance(s) to be mined (e.g., gold/silver/gravel ): Sand & Gravel 6. Owners(s) of Substance to be Mined (check applicable box(s)): X Private - State _ Federal _ Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): X Private _ State ~ Federal _ Indian 8. Type of tdining Operation (check applicable box(s)): X Surface _ Underground _ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: R PRINCIPLE c ec one 6th (Colorado) 10th (New Mexico) Ute TOWN9-IIP (write number and check direction): T 6 ~ North South RANGE (write number and check direction): R ~_ _ East ~ West SECTION (write number): S ~1 QUARTER SECTION (check one): ~-RE- NW SE SW QUARTER/QUARTER SECTION (check one): ~ NE i NW = SE i SW GENERAL DESCRIPTION: (miles and direction 2 Miles East of Havden. Colorado from nearest town and approximate elevation) * If the operator is a unit of State or county government, an application fee is not required. A fraction of an acre must be counted as one acre for fee calculation.