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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman SL. Room 215 ` C O L O RA b O <br />Denver, Colorado 80203 o r <br />Phone (303) 866 -3567 DIVISION I ANATION <br />FAX (303) 832 -8106 MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: n There is a File Number Already Assigned to this Operation <br />Permit # M - - (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) t <br />D— Conversion Application (Rule 1.11) <br />Permit # M 1 -979 -1759 _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three mayor parts: (1) the application <br />form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies ofExhibitsA -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 sholild NOT be bound or in a 3 -ring binder; maps should be folded to <br />8 1/2" X 11" 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 <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Applicantloperator or company name (name to be used on permit): Coulson Excavating CO., Inc. <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />2. Operation name (pit. mine or site name): Brownwood Pit <br />3. Permitted acreage (new or existing site): 148.7 permitted acres <br />3.1 Change in acreage ( +) 0 acres <br />3.2 Total acreage in Permit area 148.7 acres <br />4. Fees: <br />4.1 New Application $2.696.00 application fee <br />4.2 New Quarry Application $3.342.00 quarry application <br />4.4 Amendment Fee $2.229.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.69600 conversion fee <br />5. Primary commoditie(s) to be mined: SAND GRAVEL <br />5.1 Incidental commodities) to be mined: 1. - lbs/Tons/vr 2. / lbs/Tons /vr <br />3. / Ibs/I•ons/yr 4. / lbs/rons/vr 5. / Ibs/Tons/yr <br />5.2 Anticipated end use of primary commodities) to be mined: Constru - aterials <br />53 Anticipated end use of incidental commodities) to be mined(4, NTY C <br />OLORPOO ': <br />