2015-04-28_REVISION - M2014045

• Permit No: M2014045
• IBM Index Class Name: REVISION
• Doc Date: 4/28/2015
• Doc Name: Designated Mining Limited Impact Operation Reclamation Permit Application Form CN01
• From: Mineral Mountain Gold, LLC
• To: DRMS
• Type & Sequence: CN1
• Email Name: TC1
• Email Name: WHE
• Media Type: D
• Archive: No

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DIVISION OF RECLAMATION, MINING AND SAFETY
SPATE OF COLORADO
Department of Natural Resources
RECEIVED
1313 Sherman St, Room 215
Denver, Colorado 80203
APR 28 2015
Phone- (303) M&3567
A►,plicantlooerstor
FAX: [phone]
1.1
DIVISION OF RECLAMATION
DESIGNATED MININGMINING AND SAFETY
I.R.S. Tax ID No. or Social Security Number. Not for Public Record
LIMITED IMPACT (I IOd) OPERATION
Operation
RECLAMATION PERMIT APPLICATION FORM
- = �.
New Application (Rule 1.4)
Conversion Application (Rule 1. i 1)
Amendment Application (Rule 1.8 or 1.10)
Permit # M- 2014 045 (provide for Amendments and Conversions of existing permits)
COLORADO
DIVISION Of
RECLAMATION
MINING
SAFETY
The application for a Limited Impact (1 l Od) Designated :Mining Operation Reclamation Permit contains three major parts: (1) the application
form; (2) Exhibits A -J, Exhibit L, Exhibit T, the Geotechnical Stability Exhibit, the Emergency Response Plan, and Addendum 1, as required by
the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.4.20 6.5, 8, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure
to include one (1) signed and notarized Original and one (1) copy of the application form, two (2) copies of Exhibits A -J, Exhibit L, Exhibit T, the
Geotechnical Stability Exhibit (Rule 6.5), the Emergency Response Plan (Rule 8), and Addendum I (Rule 1.6.2(1)(b)), as required, and a check for
the application fee described under (4) below. Exhibits should Nff be bound or in 3 -ring binders; maps should be folded to 8 2" X I I " or 8 2" X
14" size. To expedite processing, please provide the information in the format and order described in this form.
v AF & Report
v No Violations
Office of
Mined Land Reclamation
Denver • Grand )unction • Durango
Office Of
Active and Inactive Mines
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all information described below.
Mineral Mountain Gold, LLC
L
A►,plicantlooerstor
or eompanv name tname to be used on permit):
1.1
Type of organization (corporation, partnership, etc.): LLC A
t.2
I.R.S. Tax ID No. or Social Security Number. Not for Public Record
2.
Operation
name (pit, mine or site name): Mineral Mountain Project
3.
Permitted
acreage (new or existing site): 9.5 permitted acres
0.0
M
Change in acreage ( +) acres
9.5
Total Acreage in Permit Area acres
4.
Fees: (Rule 1.5)
4.1
New Application $2,875.00 application fee
4.2
Amendment Fee (operations existing as of 0610194) $1,725.00 application fee
4.3
Amendment Fee (operations permitted from 07/01/94) S2jQQ•00 application fee
4.4
After July 1, 1995, to convert a 110(1),110(2) or a 110 to a 110(d), a new application form for a I I Od must be submitted, along
with an application fee of $2.875.00 (Rule 1.11.2(2)).
Gold and any associated minerals
5.
Primary
commodities to be mined: _
] E
6_
Tvpe
of minilte operation: Surface Underground I In -situ
v AF & Report
v No Violations
Office of
Mined Land Reclamation
Denver • Grand )unction • Durango
Office Of
Active and Inactive Mines