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DIVISION OF RECLAMATION, MINING AND SAFE <br />Department of Natural Resources <br />1313 Sherman SL, Room 215 <br />Dewar. Colorado 80203 <br />Phone: (303) 6864567 <br />FAX: (303) 8326106 <br />STATE <br />OF COLO�.DO <br />CONSMUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />�C r Ste, g1ON T. <br />I MINING <br />SAFETY <br />a_ There is a File Number Already Assigned to this operation <br />(Please reference the file number currently <br />assigned to this operation) <br />Pe it # �- Amendment Appli on yule 1.10) <br />B-- New Application (Rule 1.4.5) <br />Conversion Application (Rule 1.1) <br />(provide for Amendments and Conversions of existing Permits) application <br />Permit # .�= —= ----' _ or arts: (1) the <br />112 Operation Reclamation Permit contains three major p M: (1) fee. When you <br />on Materials Regular Geotechnical Stability Exhibit; and (3) the application of the completed <br />The application for a Construction sections of Exhibit 6.5 ( and one (1) copy . <br />form; (2) <br />Exhibits A -S, Addendum 1, ar►Y m let alp ' °`p"ri"ed o�G� cel Stability ExhibR, and achoek f°r <br />submit your application, be sure to include b i S Addendum 1, appropriate sections of6.5 (Geotecluu binder, maps should be, foided to <br />two 2 co Pic be bound or in a format application form, O P <br />the application fee described under To expedite processing- Pib s p °mod the information in the format and order described m this form. <br />8l/2 "XlVor81/2 "X14 <br />GENERAL OPERATION INFORMATION requested below. <br />-r.,w nr nrint clearly, In the space provided, AL information <br />�ppe� r or comae name t u o <br />1. ep nca P�Rq -F <br />1.1 Type of organization (corporation, partnership, etc.): Q Isi acres <br />2. •an name f4.,k mine or site nrtmgl: 1= permitted QRSER <br />CT W HyLwupe`)E A . <br />3. rermitted acre�.e (new or exi= <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />4. E: <br />4.1 New Application <br />42 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5 Primary commod:4e(s) to_be mined: rt►7 N is <br />acres <br />u acres <br />c .00 application fee <br />53.342.42 quarry application <br />_P 22 M. M. amendment fee <br />2 6 conversion fee <br />Ib ons/vr 2. / lbslr,%nc1v[ <br />5.1 Incidental commodities) to be mined: I. - <br />3. / Ibsiroas/vr 4. / IbaffA /vr 5. <br />5 2 Anticipated end use of primary commodities) to be mined: D 40A* T / Vk qAI D Dl1Ki u s /DrV lL <br />5.3 Anticipated end use of incidental commodities) to be mined: <br />