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40 DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866.3567 <br />FAX: (303) 832.8106 <br />M -2015 -008 <br />STATE OF COLORADO <br />r <br />r!�'f�,IC!N OF RECLAMATION <br />CONSTRUCTION MATERIALS <br />SPECIAL (ill) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />D I V 15 1 ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />The application for a Construction Materials Special I I 1 Operation Reclamation Permit contains four major parts:'(]) the application form; <br />(2) Exhibits A -L, Addendum 1, and any sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required by the Office, and outlined in <br />Rules 6. I , 6.2, 6.3, 6.5, and 1.6.2(1)(b), (3)the application +£se; (4) the'Performance Warranty and if required a Financial Warranty. When <br />you submit your application, be sure to include one (1) completed, signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as <br />required, a check for the application fee described under (4) below, and the fully executed Performance Warranty and Financial Warranty, if <br />required. Exhibits should NOT be bound or in 3 -ring binders; maps should be folded to 8 2" X I l" or 8 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. Applicantioperator or company name (name to be used on the permit): <br />Kirkland Construction, L.L.L.P. <br />Type of organization (corporation, partnership, etc.): Limited Liability Limited Partnership <br />2. Operation name (pit, mine or site name): Blue Valley Pit <br />3. Permitted acreage: <br />4. New Application: <br />30 Permitted Acres <br />$898.00 Application Fee <br />5. Primary eommoditie(s) to be mined: Base Course, Asphalt Aggregate, Embankment, Concrete aggregates, Bedding /Backfill <br />6. Name of owner to the surface of affected land: <br />Galloway Inc. DBA Blue Valley Ranch <br />7. Name of owner to the subsurface rights of affected land: State Land Board <br />8. Tvpe_of mining operation: 0 Surface EJ Underground <br />0 In -situ <br />9. Location information: The center of the area where the majority of mining will occur: <br />COU. Grand <br />PRINCIPAL MERIDIAN (check one): �• 6th (Colorado) � loth (New Mexico) Flute <br />SECTION (write number): S 16 <br />TOWNSHIP (write number and check direction): T 1 North I/ South <br />RANGE (write number and check direction): R 80 East ✓ West <br />QUARTER SECTION (check one): INE NW SE SW <br />QUARTER/QUARTER SECTION (check one): v NE NW ✓ SE SW <br />GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): <br />7 miles south of Kremmlincl Colorado, 75851 <br />Office of Office of <br />Mined Land Reclamation Denver ► Grand )unction • Durango Active and Inactive Mines <br />