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DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />SLATE OF COLORADO <br />RECEIVED <br />1313 Sherman St., Room 215 <br />Den I d JAN 0 2 2003 <br />pho ��� CONSTRUCTION MATERIALS <br />FAX: 8(�6f J� REGULAR (112) OPERATION Division of Minerals and Geology <br />POW V CANNI LAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a Fine Number Already Assigned to this Operation <br />Permit # M A003-oo I -� (Please reference the file number currently assigned to this operation) <br />X_ New Application (Rule 1.4.5) <br />Conversion Application (Rule 1.11) <br />Amendment Application (Rule 1.10) <br />Permit # M - (provide for Amendments and Conversions of existing permits) <br />rr <br />ckvl� <br />D IV IS ION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING-SAFETY <br />Bill Owens <br />Governor <br />Greg E. Watcher <br />Executive Director <br />Michael 8. Long <br />Division Director <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exxllubits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotechoical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) ccomnlete sided and notarized IVORY ORI and four (4) copies of the completed Ivv rx <br />application form, five (5) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should TOOT be bound or in a 3 -ring binder, maps should be folded to <br />8 1/2" X 1 I" or 8 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 /,C2,� �bsa �, 3��• <br />Type or print clearly, In the apace provided, all information described below. <br />1. Aonlicant/onerator or company name (name to be used on germit): <br />Hall -Irwin Corporation <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Operation name (pit. mine or site name): Nissen Farm Resource <br />3. Permitted acreage (new or egg ait�: <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />4_ Fees: <br />± 125.88 permitted acres <br />acres <br />f <br />125.88 acres <br />4.1 <br />New Application <br />$2.344.00 <br />application fee <br />4.2 <br />New Quarry Application <br />52.90_6.00 <br />quarry application <br />4.4 <br />Amendment Fee <br />$1.938.00 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />52.344.00 <br />conversion fee <br />5. Plimary <br />commodifts) to be mined: sand gravel <br />5.1 <br />Incidental commodities) to be mined: l.gol d/ 5 %s/fons/vr 2. 1 <br />1bsfTons/vr 3. / <br />lbs/Ponglyf <br />4. / lbs/ 2nssh2 S. / <br />lbs/Ionslvr <br />5.2 <br />Anticipated end use of primary commodities) to be mined: construction <br />material s <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: <br />Page 2 of 35 <br />