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V <br /> STATE OF COLORADO <br /> C� DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman SL,Room 215 <br /> Denver,Colorado 80203 COLORADO <br /> R r ION O N Phone:(303)U6-3567 LAMAT <br /> FAX:(303)832-8106 HARD ROCK/METAL MINING MINING <br /> REGULAR OPERATION(112) SAFETY <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: Z There is a File Number Already Assigned to this Operation <br /> r] New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> V DIVISIO" <br /> Permit#M- M _ 1992 045 (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 II"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 existing site): 9.9 permitted acres <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 New Application $2,156.00 application fee <br /> 4.2 New Quarry Application $2,674.00 quarry application <br /> 4.3 Milling Application(Non-DMO) $3,565.00 milling application <br /> 4.4 Amendment Fee $1,783.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $1,725.00 conversion fee <br /> 5. Primary commodide(s)to be mined: Gold <br /> 6. Name of owner of surface of affected land: Laurens Leffingwell <br /> 7. Name of owner of subsurface rights of affected land: Laurens Leffingwell <br /> If 2 or more owners,refer to Exhibit O. <br /> S. Type of mining operation: Placer Surface Underground In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand)unction- Durango Active and inactive Mires <br /> SCANNED <br />