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of <br /> yam' t O <br /> * G� COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY <br /> „/876• 1313 Sherman Street,Room 215,Denver,Colorado 80203 Phone(303)866-3567 <br /> TECHNICAL REVISION (TR) APPLICATION <br /> FOR INTERMITTENT STATUS <br /> (mining activities occur each year, for less than 180 days each year) <br /> Today's date: <br /> Permit number: M- Site name: <br /> County: TR number: (DBMS use only) <br /> Permittee making request: <br /> Operator(if other than permittee): <br /> Date intermittent status begins: <br /> Reason mining activities (materials extraction,processing, or hauling)will occur less than 180 days per year: <br /> Number of affected acres: <br /> Amount of financial warranty(bond) on deposit with the state: $ <br /> Required fees for technical revision by permit type (please mark the correct fee and submit it with this <br /> request for a technical revision): <br /> Permit type Required TR fee Submitted (mark only one) <br /> 110c, 111, 112 construction <br /> materials, and 112 quarries $216 ❑ <br /> 112 hard rock(not DMO) $175 ❑ <br /> 110d, 112d(1, 2 or 3) $1,006 ❑ <br /> I request intermittent status for the above-referenced permit. This site has reserves <br /> remaining to be mined. Mining activities will occur each year for less than 180 days per <br /> year. <br /> Operator's signature: <br /> Please note: <br /> 1. While in intermittent status, the operator must continue to comply with the Rules and Act, including <br /> maintaining the site, and must continue to file an annual report and annual fee when due. <br /> 2. If production ceases for 180 days or more, the operator must either file a Notice of Temporary <br /> Cessation, or reclaim the site. <br />