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A <br />ST TE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY 1 1 -.2 <br />©O 9 ^ Q L^ 3 <br />Department of Natural Resources J <br />Sherman St., Room 215 <br />Den <br />Denver, Colorado 80203 / r I C O L O R A D O <br />Phone: (303) 866 -3567 D I V I S l O N o f <br />RECLAMATION <br />FAX: (303) 832 -8106 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 Pe 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 0, (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)(6); 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 11" 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. <br />1. Applicant/operator or company name (name to be used on permit): D11S 77241 CTl 0 I LZ- G°h <br />1.1 Type of organization (corporation, partnership, etc.): p G- L L-, <br />2. Operation name (pit, mine or site name): / 0��'�IiSD !� /l'f % <br />3. Permitted acreage (new or existine site): _ permitted acres <br />3.1 Change in acreage ( +) acres <br />3.2 Total Acreage in Permit Area r'` v J '_F/ D acres <br />Dt�� <br />4. Fees: <br />4.1 New Application: $1258.00 application fee <br />Amendment Fee (C.R.S. 34- 32.5- 125(II)): $827.00 application fee <br />5. Primary commoditie(s) to be mined: , ` QC <br />s <br />5.1 Incidental commoditie(s) to be mined: 1. s /Tons /yr 2. / Ibs/Tons /vr 3. / lbs /Tons /yr <br />4. / lbs /Tons /yr 5. / lbs/Tons /vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: , /�G�- ; T X/ii'1ry tJ j rw/fi -% <br />Anticipated end use of incidental commoditie(s) to be mined: <br />