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V <br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Departro" cf Natural Resources <br />1313 Sherman SL, Room 215 <br />4.1 <br />Denver, Colorado 80203 <br />$2,156.00 <br />C O L O R A D O <br />DIVISION OF <br />Phone (303) 866.3567 <br />New Quarry Application <br />RECLAMATION <br />FAX: (303) 832 -8106 BARD ROCKIMETAL MINING <br />4.3 <br />MINING <br />$3,565.00 milling application <br />4.4 <br />Amendment Fee <br />REGULAR OPERATION (112) <br />amendment fee <br />SAFETY <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: Z There is a File Number Already Assigned to this Operation RE <br />F1New Application (Rule 1.4.5) F] Amendment Application (Rule 1.10) Ft <br />�j Conversion Application (Rule 1.11) <br />C � ni\ nr.;.,a ,,� r�r <br />VV �v Permit # M- M _ 1992 _ g45 (provide for amendments and conversions of existing permits) <br />The application for a Regular Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A -S, <br />Geotechnical Stability Exhibit and Addendum 1; and, (3) the application fee. When you submit your application, be sure to include <br />one (1) completed, signed and notarized gray original and one (1) copy of the completed application form, two (2) copies of Exhibits <br />A -S, the Geotechnical Stability Exhibit, and Addendum 1, and a check for the application fee described under Section 4 below. <br />Exhibits should NOT be bound or in a 3 -ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite <br />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 name: Gold Basin, LLC <br />1.1 Type of organization (corporation, partnership, etc.): Limited Liability Corporation <br />2. Operation name (pit, mine or site name): Gold Basin Mine <br />3. Permitted acreage (new or eristing site): 9.9 permittedacres <br />3.1 Change in acreage (+ or -) 22.4 acres <br />3.2 Total acreage in Permit area 32.3 acres <br />4. Fees: <br />4.1 <br />New Application <br />$2,156.00 <br />application fee <br />4.2 <br />New Quarry Application <br />$2.674.00 <br />quarry application <br />4.3 <br />Milling Application ( Non -DMO) <br />$3,565.00 milling application <br />4.4 <br />Amendment Fee <br />$1,783.00 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />$1,725.00 <br />conversion fee <br />5. Primary commodities} to be mined: Gold <br />6. Name of owner of surface of affected land: Laurens Leffingwell <br />7 <br />8. <br />Name of owner of subsurface rights of affected land: Laurens Leffingwell <br />If 2 or more owners, refer to Exhibit O. <br />Type of mining operation: Placer Surface <br />Office of <br />Mined land Reclamation <br />0 <br />Underground <br />In -situ <br />Office of <br />Denver • Grand }unction • Durango Active and Inactive Mines <br />