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Ae STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING�AND SAFETY <br />Department of Natural Resources M l � + -- 2 053 <br />Sherman do , Room 215 <br />Den <br />Denver, Colorado 80203 <br />Phone- (303) 866 -3567 <br />FAX: (303) 832-8106 <br />CONS`T'Rl1C PION MATERIALS <br />LIMITED IMPACT (I 10) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: 23 There is a File Number Already Assigned to this Operation <br />COLORADO <br />r)IvIs ION Or <br />RECLAMATION <br />MINING <br />SAFETY <br />Permit # M (Please reference the Ole 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 - va (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials limited Impact (I 10) 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 tee. When you submit your application, he 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 (Gcotechnical Stability Exhibit), as required, and a check for the <br />application tee described under (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps should be folded to 8 1/2" X 1 I " or 8 <br />112" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />( =I:NF,RAI. 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): AcG -9, A.JS <br />"d0 j_ 772- t T/ C lu L Z' <br />1.1 Type of organization (corporation, partnership, etc.): L.- L L _ 11-�' <br />2. Operation name (pit, mine or site name): f1 i J'v� J A'70 <br />0 <br />3. Permitted acreage (new or existing site): <br />G Q permitted acres <br />3.1 Change in acreage ( +) <br />1 <br />7 C) / % acres <br />3.2 Total Acreage in Permit Area <br />I •F/ 0 acres <br />4. fees: <br />4.1 New Application: <br />$1258.00 application fee <br />Amendment Fee (C.R.S. 34- 32.5- 1255((�II)): <br />$827.00 application fee <br />5. Primary commodities) to be mined: r t <br />5.1 Incidental commodities) to be 1. �A, i "Tonsi <br />mined: s/ T 2 / !hs /1'onslvr <br />3. 1 Ibs17'c)nsrvr <br />4. / lbsfl'ons/yr 5. i Ibsi"Tonsivr <br />5.2 Anticipated end use of primary commoditic(s) to be mined: 4 /,EGG S 7- <br />Anticipated end use of incidental commoditie(s) to be mined: <br />