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STATE OF COLORADO <br />KECEIVED <br />DIVISION OF RECLAMATION, MINING AND SAFETY _ <br />Department of Natural Resources JAN 3 0 2009 <br />1313 Sherman St., Room 215 C O L O <br />Denver, Colorado 80203 OWWon of Reclamation, <br />Phone: (303) 866-3567 and Safety Y R <br />FAX: (303) 832106 CONSTRUCTION MATER MINING <br />REGULAR (112) OPERATION ` ' AN - 9 <br />RECLAMATION PERA11T APPLICATION FORM V <br />GRAND <br />14— 0 I Bii Qll/ 8QN OF <br />RECLAhIdAT"rMINING 3 SAFETY <br />CHECK ONE: XX There is a File Number Already Assigned to this Operation Harris D. Sherman <br />Executive Director <br />Permit# M --L8 -085(Please reference the file number currently assigned to this operati$A ld W. Canny <br />New Application Rule 1.4.5) XX Amendment Application (Rule 1.10) Division Director <br />pP ( Natural Resource Trustee <br />Conversion Application (Rule 1.11) <br />Permit # _M - Z§ -085 CN --0 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 1/2" X I I " or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />Pi <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, <br />Applicantloperator or company name(name to be used on permit): <br />1.1 Type of organization (corporation, partnership, etc.): Local <br />Operation name (pit mine or site name): <br />aformation requested below. <br />offat CCoun, 13oard <br />ounty Commissioners <br />Government <br />Smith Pit No. 20 <br />3. Permitted acreage (new or existing site): <br />42.62 <br />permitted acres <br />+26.48 <br />3.1 <br />Change in acreage (+) <br />acres <br />3.2 <br />Total acreage in Permit area <br />69.10 <br />_ _ acres <br />4. Fees: <br />4.1 <br />New Application <br />$2,696.00 <br />application fee <br />4.2 <br />New Quarry Application <br />53,342.00 <br />quarry application <br />4.4 <br />Amendment Fee <br />XXX $2,229.00 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />,,,2.696.00_ <br />conversion fee <br />5. Primary connmoditie(s) to be mined: Sand Gravel Clay <br />5.1 Incidental comnmditie(s) to be mined: I, N�A _ -T <br />le 2. / lbs/Tons/yr <br />3. / lbs/Tons/yr 4. / _ Ibsr'Lons/yr 5. ! lbsffons/vr <br />5.2 Anticipated end use of primarycommoditie(s) to be mined: Road Construction Materials <br />5.3 Anticipated end use of incidental commodities) to be mined: N/A <br />Office of Office of <br />Mined Land Reclamation Denver - Grand ]unction • Durango Active and inactive Mines <br />