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(� <br /> qy-M. � STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY ©O(�w D L <br /> Department of Natural Resources / J <br /> Den Sherman St.,Room 215 /] /�/\ / <br /> Denver,Colorado 80203 //`�7�y 11 it COL O R A D O <br /> Phone:(303)866-3567 D IV 1 S 10 N o f <br /> FAX:(303)832-8106 RECLAMATION <br /> MINING <br /> SAFETY <br /> CONSTRUCTION MATERIALS <br /> LIMITED IMPACT(110)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: There is a File Number Already Assigned to this Operation <br /> Permit# M - - (Please reference the a number currently assigned to this operation) <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> Permit# M -"--OD (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Limited Impact(110) Operation Reclamation Permit contains three major parts: (1)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)(b);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 should be folded to 81/2"X I 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. ICJ <br /> 1. Applicant/operator or company name(name to be used on permit): h�oL�l�us C�e�1S T2L CTIOy LLB-/ <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Operation name(pit,mine or site name): / t'JI` I o L k rf 7- <br /> 3. Permitted acreage(new or existing site): permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 7 rJ�/3.2 Total Acreage in Permit Area "' •� t �.���� acres <br /> 4. Fees: <br /> 4.1 New Application: $1258.00 application fee <br /> Amendment Fee(C.R.S.34-32.5-125(H)): $827.00 application fee <br /> 5. Primary commoditie(s)to be mined: Roc <br /> 5.1 Incidental commoditie(s)to be mined: 1. iN fz s s Tons/3E 2. / lbs/I'ons/yr 3. / lbs/Tons/yr <br /> 4. / Ibs/Tons/yr 5. / Ibs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: /�G S XAIV <br /> Anticipated end use of incidental commoditie(s)to be mined: <br />