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DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Regular (112) Mining Operation <br />ApplicaJt/ion Worksheet/Checklist•/ ~ m -~ / <br />New App: Amendment App: n Conversion App: <br />Operator: ~fiVZ~QP1Cl ~~QL~/ nIX ~_"mier~~ ~"`~-J Mine ID: n'l l~)~(3~~J ~ <br />Mine Name: ~"(1Il'1P{/ Pr d- ~ Submittal Date: ~~~ D <br /> <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />ITEMS 1 2 3 4 5 6' <br />COMPLETED <br /> <br /> <br />+/ <br />`~ <br />/ <br />l11/v/~ / v <br />ITEMS <br />COMPLETED 7 8 9 10 11 12 <br /> <br />ITEMS CONV/AMEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> 1.~ 2/~ <br /> ,~ ~ ~ 6~ ~/ <br /> 7/S /9 / <br />MAPS and EXHIBITS (Rule 6.2) <br />ADEQUACY COMMENTS <br />EXHIBIT A - S 4 ~ - LEGAL DESCRIPTION: / <br />