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_ 11 II11 II11 I1llll !~~~~1i/E® 1~~ 141~I~I~~lll~l~~ ~ MaY na r~s0 2510 ACRE LIMITED IM..__. ..«.NrtUE1 (110(1)) AAIPJE~ j~4(yD APPLICATION FOR!! ' gMgTlCIV DWlS)ON Y'he Application for a Two Acre Limited Impact Operation Reclamaeion Permit..shall contain four major pacts: (1) this Application Fora, (2) Application Exhibits A-F, (]) an appli- cation fee, and (4) a financial warranty. When you submit your Application, be sure to include tro sixned copies of the Application Fortn, two eopie~ of Application Exhibits A-F, a check for the application fee described under (i) belor, and a financial warranty for the required amount. To expedite proeessin;, please provide the inEoc-aation in the foc-nat and order described in this form. /~'- 9Q' S`j' C~ I~~ 7 ~ l~7_~1Q 9339va3333a39333a339a3333aa3e3939aa-aaa_=Sa.n_owe.a3aa_33_-SS:aaa333a_3 3 3333-_3.._ .Sa3s GENERAL OPERATION INFORMATION $~S D(~ Type or print clearly, in the space provided, all information described below. 39 ~ JT ~!= a 9 3 9 39 3 3 3339 6 9 a 9 ~J 1. Applicant/Operator Name: Mosc~ 2. Operation Name (pit, mine or site name): ~1. d,o raJ.o - Q ,~o'~ 3. Application Type: Two Acre Limited Impact Operation (110(1)). 1. Application Fee for Permitted Acreage: Indicate permitted acreage and application .IV permitted acres. fee, (S10 x (affected acres) + S25)* and attach a check for this amount when you file your application. 1 35.Oa application fee. 5. Substance(s) to be Mined (e.g., gold/silver): C7o~c~ ~s~~vcv 6. Owner(s) of Substance(s) to be Mined (check applicable box(s)): ]~, Private ~ State _ Federal _ Indian I. Owner(s) of Reeocd of Affected Lands (check applicable box(s)): ~ Private _ State _ Federal _ Indian 8. Type of Mining Operation (check applicable 6ax(s)): _ Surface ~ Under6round _ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: O ucov PRZHCIPLE MER IID ~ (check one): _ 6th (Colorado) / 10th (Hew Mexico) _Ute TOWNSHIP (write number and check direction): T N 3 - / Nor:h _ South RANCE (write number and check direction): R 8 _ East ~[ West SECTIGN (write number): S ~_ QUARTER SECTION (check one): ? Ng v' 21W _ S8 _ SW QUARTER/QUARTER SEC?ION (check one): ~ NE _ NW ,L SE _ SW GENERAL DESCRIP?ION: (wiles and direction from nearest N 7 m~~cs S.yV. o~ O u r av town and approximate elevation) Il~q Oo' T- * A fraction of an acre must be counted as one acre far fee calculation. If the operator is a unit of state or county government, an application fee is not required. 82]6v -a-