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~~ <br />~ ~~~ Illllllllillllll <br />DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Regular (112) Mining Operation <br />Application Worksheet/Checklist <br />New App: Amendment App: /~ <br />Operator: U~1I{~1eY~#G a"X~ll(1fP~ ~CiJ~ e49 (~ <br />Mine Name: G~i K-U)0.'fP.f Yi ~ ~W <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />Conversion App: <br />Mine SD: m ~~ <br />Submittal Date: ~/I~/g ~_ <br />ITEMS 1 2 3 4 5 6 <br />COMPLETED <br /> ~ <br /> / V '~ / ,/ <br />ITEMS 7 8 9 10 11 12 <br />COMPLETED <br /> / ~ / '~ ~/ <br />ITEMS CONV/AMEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> l~ 2 3' <br /> / 4~5' 6~ <br /> 7i 8/9 ~ <br />MAPS and EXHIBITS (Rule 6.2) <br />ADEQUACY COMMENTS <br />EXHIBIT A - 6.4.1 - LEGAL DESCRIPTION:/ <br />