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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 />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: I There is a File Number Already Assigned to this Operation <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Permit # M 1� $fl 183 (Please reference the file number currently assigned to this operation) <br />E New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - 1980 183 (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 1/211 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 companv name (name to be used on Permit): _Brannan Sand and Gravel Company, LLC <br />1.1 Type of organization (corporation, partnership, etc.): LLC - <br />2. Operation name (pit mine or site name): <br />3. Permitted acreage (new or existing site),-. <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />Pit 29 <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />178.42 permitted acres <br />1.1 acres <br />179.52 acres <br />$2,696.00 <br />application fee <br />$3.342.00 <br />quarry application <br />_$2,229;00 <br />amendment fee <br />$2,696.00_ <br />conversion fee <br />5. Primary commodities) to be mined: Aggregate Sand <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/wr 2. / Ibs/Tons/ <br />3. / Ibs/Tons/ 4. / lbs/Tons/ 5. ! lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Asphalt and Concrete <br />5.3 Anticipated end use of incidental commodities) to be mined: FIII <br />