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9/18/2015 Notice for Release Request - dnr_drmsminadmin@state.co.us - State.co.us Executive Branch Mail <br />nver, CO 80203 <br />' I <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Shemwn St., Room 215 <br />Denver, Colorado 80203 CONSTRUCTI <br />Phone: (303) 666-3567 <br />fAX: (303) 832-8106 REGULAR (I1 <br />RECLAMATION PERM <br />CHECK ONE: X Then is a File Number Already Ass <br />Permit # A - (Please t eferenc <br />New Application (Rule 1.4.5) <br />Conversion Application (Rule 1.11) <br />Permit # Imo- 7 7 - 5 34 - (provide for Amend <br />The application for a Construction Materials Regular 112 Operation <br />(2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotreclu <br />application, be sure to include one (1) ggmplete si� and notarized <br />form, two (2) copies ofExhibits A -S, Addendum 1, appropriate sear Last account activ <br />fee described under Section (4) below. Exhibits should N0J be bou houi <br />14" size. To expedite p w sing, please provide the information in Dt <br />GENERAL OPERA <br />Type or print clatrly, its the space pro <br />1. AgDDmWenerator or c�oao�alg)'. nate(name to be Big o <br />1.1 Type of organization (corporation, partnership, etc.): _ <br />1.2 I.R.S. Tax I.D. No. or Social Security Number. QR <br />2. Operatbn nnslsee Pit. tis er site name): $A1' I r e P i t <br />3. Permitted aeremm (am py eabft ske): <br />3.1 Change in acreage (+) <br />3.2 Total acreage is Permit area <br />4. f=,- <br />4.1 <br />,:4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />■ r w�----- -.---- -ft.e - i-" - 3-- --l- 8 e, — — j n <br />https://mail.google.com/mail/u/1 /#label/01 +DENVER%2FCunningham%2C+Michael/l 4fe22d5O9746e62?projector=1 1/1 <br />