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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAf ff RECEIVED <br /> Depa"of Naaml Resources <br /> 1313�''�°°'"21s JUN 19 2014 COLDP DO <br /> Dw.w, 8=3 <br /> PhOrrt~(303)866 3567 [DIVISION O F <br /> FAX:(303)832.8106 DIVISION OF RECLAMATION RECLAMATION <br /> MINING <br /> MINING AND SAFETY <br /> LIMITED IMPACT OPERATION(110(2)) <br /> SAFETY <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CHECK New Application(Rule 1.4) F� Conversion Application(Rule 1.11) <br /> Permit#M--ILH - vi"3 (provide for conversions of existing permits) <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 <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 /> (Geotechmical 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 I"or 8 1/2"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 /> I. Applicant/operator or company name(name to be used on the permit): 'BLUE CN'a Z &-pL,6gA 1 I o N .t-L C <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Operation name(pit.mine or site name): 13 t-o! 6��R <br /> 3. Permitted acreage(new or existing site): permitted acres <br /> 4. Few <br /> 4.1 New Application $1006.00 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 commoditie(s)to be mined: M i"aAA-f- SPF—CI m r nt 5 <br /> 6. Name of owner to the surface of affected land: a LM 1=E R R-'-r SE F2 J I L E <br /> 7. Name of owner to the subsurface rights of affected land: <br /> 8. Type of mining operation: El Surface Underground _l In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and tractive Mines <br />