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:;TATE OF COLORAIX� <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Deponment of NatualResources RECEIVED <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Kw w- (303) 8663567 APR 2 8 2015 <br />FAX: (303) 832-8106 <br />DIVISION OF RECLAMATION <br />DESIGNATED MININGMINING AND SAFETY <br />LIMITED IMPACT (I 10d) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: <br />CK4/ I <br />New Application (Ru►c 1.4) <br />Conversion Application (Ruk 1.11) <br />0 Amendment Application (Rule 1.8 or 1.10) <br />Permit N M- 2014 045 (provide for Amendments and Conversions of existing permits) <br />COLORADO <br />DIVISION or <br />RECLAMATION <br />MINING <br />SAFETY <br />The application for a Limited Impact (I 10d) Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -J, Exhibit L, Exhibit T, the Geotechnical Stability Exhibit, the Emergency Response Plan, and Addendum 1, as required by <br />the (Juice, 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 <br />to include one (1) signed aril notarized Oriainal and one (1) copy of the application form, two (2) copies of Exhibits A -J, Exhibit L, Exhibit T, the <br />Geotechnical Stability Exhibit (Rule 6.5), the Emergency Response Plan (Rule 8), and Addendum 1(Rule 1.6.2(1)(b)), as requited, and a check for <br />the application foe described under (4) below. Exhibits should D= be bound or in 3 -ring binders; maps should be folded to 8 2" X 1 I " or 8 2" X <br />14" sire. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL, OPERATION INFORMATION <br />Type or print ekarly, In the space provided, all Information described below. <br />I . Applicant/operator or company name (name to be used oa permit): Mineral Mountain Gold, LLC _ <br />1. ; T}pe of org2nization (corporation, partnership, etc.): LLC <br />1.2 I.R.S. Tax ID No. or Social Security Number: Not for Public Record <br />2. ()aeration name (pit, mine or site name): Mineral Mountain Project <br />3. Permitted acreage (new or existing site): 9.5 permitted acres <br />3.1 Change in acreage (+) 0.0 acres <br />Total Acreage in Permit Area 9.5 acres <br />4. Fees: (Rule 1.5) <br />4.1 New Application $2.875.00 application fee <br />4.2 Amendment Fee (operations existing as of 06/30/94) S1.725.00 application fee <br />4.3 Amendment Fee (operations permitted from 07/01/94) $2304.00 application fee <br />4.4 After July 1, 1995, to convett a 110(1), 110(2)ora 110 to a 110(d), a new application form fora I l 0d must be submitted, along <br />with an application fee of $2,875.04 (Rule 1.11.2(2)). <br />5. Primary commodities to be mined: (Gold and any associated minerals <br />6- Type of mining operation: L,1 Surface n Underground 1-1 In-situ <br />AF & Report <br />No Violations <br />Office of <br />Mimi land Reclsnation <br />Deriver " Grand junction • Durango <br />Office of <br />Active and Inactive Mines <br />