2015-08-04_REVISION - M2002087

• Permit No: M2002087
• IBM Index Class Name: REVISION
• Doc Date: 8/4/2015
• Doc Name: Notices SR01
• From: DRMS
• To: various
• Type & Sequence: SR1
• Media Type: D
• Archive: No

DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
STATE OF COLORADO
RECEIVED
1313 Sherman St., Room 215 -1`110111111
Denver, Colorado 80203 AUG 13 2002 ✓ D t v I S t ON OF
Phone: [phone] MINERALS
FAX: [phone] Division of Minerals and Geology &
GEOLOGY
CONSTRUCTION MATERIALS RECLAMATION
C L A M AT I O N
FILE COPY
MINING -SAFETY
LIMITED IMPACT (110) OPERATION
FOR SCANN/N ECLAMATION PERMIT APPLICATION FORM Bllc�� S
Greg E. Walcher
/ Executive Director
" -200 a — 0 e7 Michael B. Long
v on Director
CI-ZECK ONE: New Application (Rule 1.4) CooversIon Application (Rule )°� i�
Amendment Application (C.R.S. 34-32.5-1 t0)
Permit # .� _ (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (110) Operation Reclamation Peratit contains three major parts: (1) the application forst;
(2) Exhibits A-1, Exhibit 1, Addendum 1, any sections of Exhibit 6.5 and Geotechnical StabitityExhibit, as required by the Office, and outlined in Rules
6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one (1) Rggrd and
notarized IVORY ORIGINAL and one (1) copy of the completed hm application form, two (2) copies of Exhibits A-1, Exhibit L, Addendum I,and
appropriate sections of 6.5 (Geotechnical StabilityExhibit), as required, and a check for the application fee described under (4) below. Exhibits should
N ,Z be bound or in a 3 -ring binder; maps should be folded to 812" 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.
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, ALL information described below.
1. Ayylicautloperator ol�r r l t�L
mpany name (name to be used on permit):
k- . L --C ✓
1.1 Type of organization (corporation, partnership, etc.):
1.2 I.R.S. Tax ID Na. or Social Security Ni
2. Operation name (piht mine or site name):
3. Permitted acreate (new or exMing site):
3.1 Change in acreage (+)
Total Acreage in Permit Area
4. Fees:
4.1 New Application:
Amendment Fee (C.R.S. 34-32.5-1250):
4.2 Conversion Fee (from 110d to 110 $875.00 conversion fee (Rule 1.11.2(2))
5. Primary comm—P ties) to be mined:
_.f-.._ permitted acres
~' acres
acres
$1.094.00 application fee
719.00 application fee
5.1 Incidental commodities) lobe mined: I. / lbsfrons/wr 2. _ / )bslfon3. / lbsribns/w
4. lbsITons/ 5.
5.2 Anticipated end use of primary commodities) to be mined: jg�AA -OA! !` A&D t244- MftWlki,
5.3 Anticipated end use of incidental commodities) to be mined: