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� STATE F <br /> O COL0IKADQ <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St,Room 215 <br /> Denver,Colorado 80203 C O L O R A D O <br /> Phone:(303)866-3567 D l y t s l o N o f <br /> FAX:(303)832-8106 RECLAMATION <br /> MINING <br /> LIMITED LNZPACT OPERATION(110(2)) SAFETY <br /> RECLAMATION PERMIT <br /> APPLICATION FORM RECEIVED <br /> CHECK ONE: New Application(Rule 1.4) Conversion Application(Rule 1.1 I) JUN 09 ?014 <br /> Permit#MAC14—C1� WWMY(provide for conversions of existing permits) <br /> lr �SI�E�1t <br /> The application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br /> form; (2) Exhibits A-J, any required sections of Exhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in <br /> Rules 6.1,6.2,6.3,6.4.19 and 6.5; and(3)the application fee. When you submit your application,be sure to include one(1)signed an <br /> notarized original and one(1)copy of the application form,two(2)copies of Exhibits A-J,appropriate sections of 6.4.19 Exhibit S and 6.5 <br /> (Geotechnical Stability Exhibit),as required,and a check for the application fee described under(4)below.Exhibits should not be bound <br /> or in a 3-ring binder;maps should be folded to 8 1/2" X I 1"or 8 I/2" X 14"size. To expedite processing,please provide the information <br /> 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 the permit): Blue Star Exploration LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Sole Proprietor LLC <br /> 2. Operation name(pit,mine or site name): Blue Star #1 <br /> 3. Permitted acreage(new or existing site): permitted acres <br /> 4. Fees: <br /> 4.1 New Application $1,006.00 application fee <br /> 4.2 Amendment Application(from 1.10(2)) <br /> 4.3 Conversion Fee(from 110d to 110(2),(Rule 1.11.2(2)) $1.725.00 conversion fee <br /> 5. Primary commodities)to be mined: Aquamarine, Topaz, Flourite& Phenacite&other GemMineral Specimens <br /> 6. Name of owner to the surface of affected land: BLM Forest Service <br /> 7. Name of owner to the subsurface rights of affected land: North American Beryllium Corporation <br /> 8. Type of mining operation: R1 Surface Underground W] In-situ <br /> Office of <br /> Mined land Reclamation Denver of <br /> Denver • Grand junction . Durango Active and Inactive Mines <br />