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tics STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY RECEIVED <br /> Depwhuent of Natural Resources <br /> 1313,9hwnan St-.Room 215 <br /> worado aum MAY 2 0 2014 C O L O RA n O <br /> Phone.(3t13)t�35b7 DIVISION O F <br /> RECLAMATIONFAx(303)83241e6 <br /> DIVISION OF RECIA"IATION MINING <br /> pY11NiNC AND SAFETY SAFETY <br /> CONSTRUCTION MATSRiAIS <br /> REGULAR(112)OPERATION <br /> BECI.AMATIO14 PERMIT APPLICATION FORM <br /> CHECK ONE: X There is a File Number AlIrmdy Assigned to this Operation <br /> Pen M -1947 -039 (Please reference the file number cwr�ty awned to 9 age�ian) <br /> Ncsr Application(Rule 1.4-5) Amendment Application(Rule 1.10) 4 <br /> X Conversion Application(Rule 1.11) <br /> v` Permit# M -1997 ,43!(provide for Amendments and Cauvcrsw es ofraus ft per) <br /> The application for a CansfrvQioa Materials Regular 112 Operation Reclamation Permit contains ogee major parts:(1)the application <br /> forum;(2)Fxbfl)its A-S,Addendum 1,any sections of Bxhibit 6.5(Gootedmical ShAmTky FxhiFiit;and(3)the application fee. When you <br /> submit your spplic s ion,be sum to include one(1)MM*k signed and wtadwd ORIGINAL and one(1)copy of the completed <br /> application form,tvm(2)copies&T b&b AA Addendum 1,appr deftsections of6S(Goot ch"SwbikyBM)14 and ache&for <br /> the applicabon foe described under Section(4)below Fxbabft should I=be bound or In a 34mg binder;maps should be folded to <br /> 812'X 11'or 812'X 14'scot. To expedite processing,please providcthe taftwation in the format and order descxi'bod in this form <br /> (02URAL OPERATION INFORMATION <br /> Type or print dearly;to dw space prwvlded,AM iatEarim requested below- <br /> 1. Oe� <br /> 1.1 Type of oqpAntian(c oq m dony prtnershipy eb4 cation <br /> Z. WiIliams/IDioois Gravd Pit <br /> 3. 9.99 permittedacres <br /> 3.1 Chafe in acreage(t) .IA4" fires <br /> 32 Total acreage in Permit area }40 <br /> 4. Y= <br /> 4.1 NewApplication S26960 application fee <br /> 42 NewQuarry Application 53.W-- quarq qV <br /> 4.4 Amendment Foe S2229A amendment fee <br /> 4.5 Conversion to 112 opsation(set by sWkft) S2j6960 conversion fee <br /> 5. Sand Gravel <br /> 5.1 Incidental oommoditie(s)to be mined: 1. N/A - Ibs/Tans/vr 2- <br /> 3.— / 1bslfons/vr 4._ I IbsJTon4/vr 5. / 16s/lons/vr <br /> 52 And0pated end use of pommy commodities)to be mined:Rued Con*ucdm and Construction M01job <br /> 53 AnOc4 bed end we of iaeidmtal commo&K(s)to be mmed_ NIA <br /> �' C-) <br />