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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 />STATE OF COLORADO <br />�o1L7)M COLORADO <br />DIVISION OF <br />Y RECLAMATION <br />MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: Q— There is a File Number Already Assigned to this Operation <br />Permit # MI-980 Q20 - (Please reference the file number currently assigned to this operation) <br />0— New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M 1980 (20 - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major 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 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 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. <br />Applicant/oyerator <br />or company name (name to be used on permit): AIRS Sand & Gravel <br />1.1 <br />Type of organization (corporation, partnership, etc.): Corporation <br />2. <br />Operation name (pit mine or site name): AIRS Sand & Gravel <br />3. <br />Permitted acreage (new or existing site): 82.96 <br />permitted acres <br />3.1 <br />Change in acreage ( +) 22.06 <br />acres <br />3.2 <br />Total acreage in Permit area 105.02 <br />acres <br />4. <br />Fees: <br />4.1 <br />New Application $2,696.00 <br />application fee <br />4.2 <br />New Quarry Application $3,342.00 <br />quarry application <br />4.4 <br />Amendment Fee $2,229.00 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) $2,696.00 <br />conversion fee <br />5. <br />Primary commoditie(s) to be mined: Open Pit Sand Gravel <br />5.1 <br />Incidental commoditie(s) to be mined: 1. - lbs/Tons/vr 2. / <br />lbs/Tons /vr <br />3. / lbs/Tons /vr 4. / lbs/Tons/vr 5. / <br />lbs/Tons/vr <br />5.2 <br />Anticipated end use of primary commoditie(s) to be mined: Construction <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: N/A <br />#2015020863, 04/02/2015 at 11:19:21 AM, <br />1 OF 32,Rec Fee $166.00 <br />Douglas County CO Merlin Klotz, Cleric & <br />EXHIBIT R <br />Recorder <br />