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RECEIVED <br />JAN 14 20045TATE OF COLORADO <br />,/DIVISION OF MINERALS AND GEOLCT + "n of Minerals and Geology <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 CONSTRUCTION MATERIALS <br />FAX: (303) 832 -8106 REGULAR (112) OPERATION FILE COPY <br />RECLAMATION PERMIT APPLICATION F R CP A A]N! <br />HECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M -_$Q - 183-Z (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) <br />Conversion Application (Rule 1.11) <br />X Amendment Application (Rule I.10) <br />Permit # M -3_Q_- 183 - (provide for Amendments and Conversions of existing permits) <br />D I V I S I O N O F <br />MINERALS <br />EOLOGY <br />CLAMATION <br />1NI XSAFETY <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Michaei S. tong <br />Division Director <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotecbnical Stability Exhibit; and (3) the application fee. When you submit your <br />application. be sure to include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) 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, Dlibits should NOT be bound or is a 3 -ring binder; traps 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 />GENERAL OPERATION INFORMATION <br />Type or print clearly, to the space provided, all information described below. <br />I. Applicaut/oReerator or company name (name to be used on permit): <br />1/ Brannan Sand $ Gravel Company <br />1.1 Type of organization (corporation, partnership, etc.): i. ,C. <br />1.2 I.RS. Tax I.D. No. or Social Security Number: 84- ] 26,3435 <br />2- Operation name pit, mine or site name): Pit 29 <br />3. Permitted acreaee (new or existing site); <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(a) to be mined: Sand and Gravel <br />30.64 permitted acres <br />176.24 acres <br />excluding Nome St. R.O.W. <br />acres <br />$2. 344.00 application fee <br />$2,906.00 quarry application <br />$L938.00 amendment fee <br />$2.344.00 conversion fee <br />5.1 Incidental commoditie(s) to be mined: 1. / ibs/Tous/vr 2. / lbs/Tons/vr 3. / Ibs/TonsJvr <br />4. / lbs/Tons/vr 5. / lbs/Tous/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: _ Asphalt /Concrete <br />5.3 Anticipated end use of incidental commodities) to be mined: <br />