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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources A �y / <br />1313 Sherman St, Room 215 /` /" Yf� // <br />Denver, Colorado 80203 C O L D RADO <br />I ON OF <br />Phone: (303) 866 -3567 RECLAMATION <br />FAX (303) 832 -8106 MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: R There is a File Number Already Assigned to this Operation <br />Permit # M - 1983 -028 -_ (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1, 4.5) 0— Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1 11) <br />Permit # M -1983 =028 - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three mayor parts (1) the application <br />form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6 5 (Geotechnical Stability Exhibit, and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6 5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below Exhibits should NOT be bound or in a 3 -ring binder, maps should be folded to <br />8 1 /2" X 11" or 8 1/2"X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />M1983 -083 Conversion AUG13 <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />L Applicant <br />/operator or company name (name to be used on permit) • Stolle Sand & Gravel, LLC <br />1.1 <br />Type of organization (corporation, partnership, etc ) Limited Liability Company <br />Wallace Pit <br />2. Operation <br />name (pit, mine or site name). <br />3. Permitted <br />acreage (new or existing site): <br />9.9 <br />permitted acres <br />RECEIVED <br />240.1 <br />3.1 <br />Change in acreage ( +) <br />acres <br />3.2 <br />Total acreage in Permit area , , ; „+ <br />250.0 <br />acres <br />4. Fees: Division of Reclamabon, <br />4 1 <br />New Application Mining & SafetX <br />$2,696.00 <br />application fee <br />42 <br />New Quarry Application <br />$3,34200 <br />quarry application <br />4.4 <br />Amendment Fee <br />$2,229.00 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />696. <br />conversion fee <br />5 Primary commoditie(s) to be mined- Sand Gravel <br />5.1 <br />Incidental commoditie(s) to be mined 1 - lbs /Tons /yr 2. <br />/ <br />lbs/Tons/yr <br />3. / lbs/Tons,'yr 4 / lbs /Tons /vr 5 <br />/ <br />lbs/Tons/yr <br />52 <br />Anticipated end use of primary commoditie(s) to be mined: Construction materials <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined- Not applicable <br />M1983 -083 Conversion AUG13 <br />