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DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS / <br />Regular (112) Mining Operation / <br />Application Worksheet/Checklist/// <br />New App: ~, Amendment App: Conversion App: <br />Operator: l~ U ~(Ye~n~~reS -h~E'`d.~ lr~r// Mine ID: [~2/b/)U0~1 Z1 / <br />Mine Name: ~u!'SC3Y~ ~~l`~-h ~fShcl~~P / Submittal Date: ~/15fOt/ <br />APPLICATION FORM (Rule 1.6..2 and 1.6.3): <br />ITEMS <br />COMPLETED 1. 2 3 4 5 6' <br /> (/ v v ~ ~ <br />ITEMS <br />COMPLETED 7 8 9 10 it 12 <br /> ,~. / / <br />ITEMS CONV/AMEND PERMITEE SIG <br />COMPLETED DESCP RESP <br /> 1/~/3/ <br /> cA/5/ ~ / <br /> 7 /8/9 ~ <br />MAPS and EXHIBITS (Rule 6.2) <br />~fCd COnGUftd~n <br />ADEQUACY COMMENTS <br />EXHIBIT A - 6.4.1 - LEGAL DESCRIPTION: <br />