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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources R E C E - W E <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />I-- OCT 16 2015 <br />DIV1Si0,' OF RECLAMATION <br />MINING AND SAFETY <br />CONSTRUCTION MATERIALS <br />a 7 'LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />COLORADO <br />D IV IS 10 N OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Permit # M - - (Please referencq the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />I/ Permit # M --- (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A -J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by <br />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 <br />to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of <br />Exhibits A -J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described under (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps should be folded to 8 1/2" X 11" or 8 <br />1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. ApWicant/overator or company name (name to be used on permit): ►V'GSI 7-0-iJC/iLI <br />1.1 Type of organization (corporation, partnership, etc.): tZ+�M"0 <br />2. Operation name (pit, mine or site name): L, <br />3. Permitted acreage (new or existing site): �, 10 permitted acres <br />3.1 Change in acreage (+) Z "5 - <br />acres <br />3.2 Total Acreage in Permit Area acres <br />4. Fees: <br />4.1 New Application: <br />$1258.00 <br />application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): <br />$827.00 <br />application fee <br />5. Primary commoditie(s) to be mined: EuclG cl/+V,/-t <br />SAM-) <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/Tons/yr <br />2. / lbs/Tons/vr <br />3. / <br />lbs/Tons/yr <br />4. / lbs/Tons/yr <br />5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />l (.6XJi'i� ✓E <br />(� JZ� �j,�SM <br />Anticipated end use of incidental commoditie(s) to be mined: <br />� 2014 Annual Fee/Report (no Map) <br />2015 Annual Fee/Report/Map due 8/24/2015 <br />J Violations <br />MV1992011 2/26/1992 <br />MV1992020 3/25/1992 <br />