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ics46 <br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Coloradot I% Rtis p <br />Phone. (303) 866- <br />FAX• (303) 832-810 <br />NOV 18 2015 <br />DIVISION OF RECLAMATION CONSTRUCTION MATERIALS <br />MINING AND SAFETY REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE. 11 There is a File Number Already Assigned to this Operation <br />Permit # M - (y `) 'z —IC? i (Please reference the file number currently assigned to th <br />ELNew Application (Rule 1.4 5) <br />Conversion Application (Rule 1.11) <br />Permit # M - 199 �' 1 GI (provide for Amendments and Conversions of existing permits) <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />—&— <br />SAF ETY <br />Amendment Application (Rule 1.10) <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 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). 1WN0i ?, LTRAITPC" SG'NS, PVC- <br />1.1 <br />NC1.1 Type of organization (corporation, partnership, etc ). iJWC:l -A11 G'(U <br />2. Operation name (pit, mine or site name)' <br />Permitted acreage (new or existing site). <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />PiT- <br />4. Fees - <br />4.1 New Application <br />4 2 New Quarry Application <br />4 4 Amendment Fee <br />5 Conversion to 112 operation (set by statute) <br />Primary commoditie(s) to be mined. <br />5.1 Incidental commoditie(s) to be mined: <br />P -AV <br />1. Q� -;0 lb onsiyr <br />1 be permitted acres <br />NO" C HPoUGi: acres <br />t,A acres <br />$2,696.00 application fee <br />3 342.01 quarry application <br />mendment fee <br />. ".. i conversion fee <br />on �. <br />2. 6e, ceC <br />3. 3 C,, took) lb Tons r 4. / lbs/Tons/yr 5 <br />5.2 Anticipated end use of primary commoditie(s) to be mined' (e/\151 1?JJC: I ((JTV 6 - -DL 466. L {JE,5 <br />5.3 Anticipated end use of incidental commoditie(s) to be mined' I I < i i <br />lbs/Tons/yr <br />141 IOC& l%° id cae- <br />