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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />STATE 0- COLORADO <br />JAN 15 04- <br />DIVISION OF RECLAMATION <br />MININGAND SAFETY <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (1I#) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />D! Y IS I ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />CHECK ONE: 11 There is a,,//File Number Already Assigned.tathis.Operatian_ <br />� -7' <br />Permit # M vj `" 00-S (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) =Amendment Application (Rule 1.10) <br />HConversion Application (Rule 1.11) <br />Permit # M - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major pares: (])the <br />application form; (2) Exhibits A -J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by <br />the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When you submit your application, be sure <br />to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of <br />Exhibits A -J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described under (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps shoulctbcfolded to 81/2" X 1 I" or 8 <br />1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Applicant/operator or company name (name to be used on permit): 0 ' 0 L'r- f �aC C C; V'01 F - A <br />1.1 Type of organization (corporation, partnership, etc.): Cor Po i ^c T1� <br />C r� <br />2. Operation name (pit, mine or site name). CJ 1 01,1, S n dl { �C C2 11 <br />3. Permitted acreage (new or existing site): OS, permitted acres <br />3.1 Change in acreage ( +) (yT acres <br />3.2 Total Acreage in Permit Area acres <br />4. Fees: <br />4.1 New Application: $1258.00 application fee <br />Amendment Fee (C.R.S. 34- 32.5- 125(II)): application fee <br />5. Primary commodities) to be mined: SCm A &r ( Fit .1 "T_ <br />5.1 Incidental commodities) to be mined: 1. / lbsfrons /yr 2. / Ibsrrons/vr 3. / lbs/Tons /vr <br />4. / Ibs/Tons /vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: CC {j & se i A sla ba 7 57tt^Lot TUtej F <br />Anticipated end use of incidental commodities) to be mined: /i/ A <br />