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Casual Use Placer Operations Notification - United States Department Of The Interior

United States Department of the Interior

BUREAU OF LAND MANAGEMENT

UNCOMPAHGRE FIELD OFFICE

2465 South Townsend

Montrose, CO 81401

43 CFR 3809 - CASUAL USE

PLACER OPERATIONS NOTIFICATION

OPERATOR NAME:

DATE:

ADDRESS:

PHONE:

EMAIL:

MOTORIZED OPERATION TYPE (Check all that apply):



Dredge

Highbanker

Sluice

Dry Washer

Trommel/Screen



Other (Specify)

INTAKE HOSE DIAMETER (not to exceed 4”)

ENGINE SIZE (not to exceed 10hp)

RATED CAPACITY OF EQUIPMENT (cubic yards per hour)

NON-MOTORIZED OPERATION TYPE (Check all that apply):



Sluice

Pan

Other (Specify)

/2016 ANTICIPATED END DATE:

/2016

ANTICIPATED START DATE (Month/Day):

LOCATION OF OPERATIONS - Identify all areas you propose to work in and include a Location Map(s):

Township

Range

Section(s)

¼-Section

Township

Range

Section(s)

¼-Section

Township

Range

Section(s)

¼-Section

CLAIM INFORMATION (if applicable):

Claim Name

Claim #: CMC-

Claim Name

Claim #: CMC-

Claim Name

Claim #: CMC-

Claim Name

Claim #: CMC-

DESCRIBE CLAIM ACCESS:

By signing this document:



I agree to comply with all applicable management practices on page two of this notification.



I agree to notify the BLM Uncompahgre Field Office when I have ceased operations.



I agree to reclaim any disturbance created under this notification.



I understand that this notification does not authorize me to:

access private land

operate on an unpatented mining claim without permission

use toxic or hazardous chemicals

OPERATOR SIGNATURE:

DATE:

CLAIMANT SIGNATURE:

DATE:

BLM SIGNATURE:

DATE:

Casual Use Placer Operations Notification - United States Department Of The Interior

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