2015-10-06_REPORT - M1977443

• Permit No: M1977443
• IBM Index Class Name: REPORT
• Doc Date: 10/6/2015
• Doc Name: Application SO02
• From: Moon Pit #2
• To: DRMS
• Type & Sequence: SO2
• Email Name: ACY
• Email Name: GRM
• Media Type: D
• Archive: No

S 5 S
STATE OF COLORADO
DIVISION OF RECLAMATION, MINING AND SAFETY
Dqwbnent of RECEIVE,)
1313 Shelinm SL, Room 215 ` \/
W`W•Cobrado W203 ` / COLORADO
Phone: [phone] FEB 2 tl D, v t: i G N O f
1 1 ��� RECLAMATION
Fix: {) e32�1o6 G J z MINING
REC foF MINING SAFETY
rMt'id & QTY
CONSTRUCTION MATERIALS
MUM .3r.
LMITED IMPACT (110) OPERATION Govemor
Maris D. Shomm
RECLAMATION Pnwr APPLICATION FORM F Meow
RaWWw. CMA"
Divi w Dkedw
CHECK ONE: There is a File Number Already Assigned to this Operation N1"W ROOO11 C Tnatee
Permit # M_ (Please reference ffie "mins currently assigned to this operation)
New Application (Rule 1.4.5) Amendment Application (Rule 1.10)
Conversion Application (Rule 1.11)
Perrnit # _- _�.!-L.7 M _Tt3-._._ (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three majorparts: (1) the
application form; (2) Exhibits A-1, Exhibit L, Addendum 1, airy sections of Exhibit 6.5 and Geotechnical Stability Exhibit, 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 submityour application, be
sure to include one (1) complete Am ed and notarized ORrINA) . and one (1) copy of the completed application form, two (2) copies
of Exhibits A -i, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for
the application fee described under (4) below. Exhibits should LOOT be bound or in a 3 -ring binder; maps should be folded to 8112" X
1 i" or 8 112" 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 dearly, in the space provided, ALL information described below.
i. Applidant/oDerator or company name tname to be used on permit): j�t; 1(�t',1L+ , BJP
1.1 Type of organization (corporation, partnership, etc.):g
2. Operation name folt. mine or site name):
3. Per_MWed acreage (new or 4 site): _Tatted atm
3.1 Change in acreage (+) acres
3.2 Total Acreage in Permit Area,
4. Fees: acres
4.1 New Application: U .00 applicatkrn fee
Amendment Fee (C.R.S. 34-32.5-125(6)): SS27.00 application fee
4.2 Conversion Fee (from I l Od to 110$2-6%-00conversion fee (Rule 1. 11.2(2))
5.
him Wy commod WSW to betoed:.. S r�.
5.1 Incidental commodities) to be mined: 1. I ibs/Tona/vr 2. / IbsJT ons/vt 3. / llralTons/vr
4. I Ibslionslvr 5. 1 IbsiTonslvr
5.2 Anticipated end use of primary commodities) to be mined:
Anticipated end use of incidental commodities) to be mined:-
k""
ined:
k"" of
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