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3 <br /> OF CO4O <br /> yam:. DEPARTMENT OF NATURAL RESOURCES <br /> r* <br /> David H.Getcr+ea Executive Director <br /> MINED LAND RECLAMATION DIVISION <br /> DAVID C.SHELTON, Director <br /> Richard D.Lamm <br /> Governor <br /> Application Form for a Permit — <br /> to <br /> Conduct Coal Mining in Colorado <br /> Application to conduct surface or underground coal mining activities or other <br /> surface coal mining and reclamation operations in Colorado pursuant to C.R.S. <br /> 1973, 34-33-101, et seq. <br /> For an application to be deemed complete by the Division pursuant to C.R.S. <br /> 1973, 34-33-103(5) and Rule 1.04(30), an applicant must: (1) supply all <br /> information as specified on this application form; (2) submit five <br /> reproducible copies of the permit application with original signatures ; and <br /> (3) pay the appropriate fee required by Rule 2.01 .6. <br /> Please note that this form is only a listing of general category requirements <br /> and does not constitute a checklist of detailed permit application <br /> requirements. A finding of completeness should not be interpreted to imply <br /> adequacy of an application. Additional information not listed on this form <br /> may be required for adequacy depending upon the individual circumstances of an <br /> 9 application. <br /> This form consists of two major parts: (1) a section entitled (General <br /> Operation Information and (2) a section entitled Application Require nts. <br /> Specific instructions for filling in the necessary information for each <br /> section appears immediately below the title of each section. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly the appropriate information as listed below. <br /> Supplemental sheets may be used as necessary, such sheets must be attached to <br /> the form and referenced or keyed to the numbers on the form. <br /> 1. Name of Operation Grassy Gao Coal reline <br /> (Pit, mine or site name) <br /> 2. Name of Applicant The Rockcastle Company <br /> (Name to be used on permit - <br /> the Permittee) <br /> 2a. Address and phone number of P.O. Box 773987 Office: (303) 379-7110 <br /> local offices Steamboat Spgs. , Co 90477 Mqr.. res.: 35 <br /> i 2b. Address and phone number of P.O. Box 1038 <br /> general offices. I Janesville, Hisconsin 53545 <br /> I (608) 754-2291 <br /> 423 Centennial Building, 1313 Sherman Street Denver, Colorado 80203 Tel.(303)866-3567 <br />