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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />RECEIVED <br />Nov 12 4015 <br />DIVISION SON <br />MINING AND SAFE1Y <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: © There is a File Number Already Assigned to this Operation <br />Permit # M - J) OW - (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) m Amendment Application (Rule 1.10) <br />® Conversion Application (Rule 1.11) <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Permit # M - I't') 010 - <br />(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 mpleted <br />application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a heck 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 11" or 8 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 requested below. <br />1. Applicant/operator or company name (name to be used on permit): A t. %4 P r O dlu.c.4- r • <br />1.1 Type of organization (corporation, partnership, etc.): 5 C o T p pP Q.4- : O n <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />1''1/4 V �.t' £. <br />4. Fees: <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 />( Pc/ <br />✓av;dl4400 <br />(O $ permitted acres <br />e.7 34k0 I acres <br />131.3t.1 <br />acres <br />I„ o f/ $2,696.00 application fee <br />$3,342.00 quarry application <br />(/. / �Ae .0i S $2,229.00 amendment fee <br />)7 $2,696.00 conversion fee <br />5. Primary commoditie(s) to be mined: Sq ✓tel Gr4.0e( <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/yr 2. / lbs/Tons/yr <br />3. / lbs/Tons/yr 4. / lbs/Tons/yr 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: 99 reg a{-eS <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: Il//A <br />