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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of tlatura 1 Resources <br />1313 Sherman St . Roam 215 <br />Denver, Coloiada 80203 <br />Phone (303) 866-3567 <br />FAX (303) 832 8106 <br />STATE OF COLORADO <br />AMO4 ' <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />CHECK ONE: UThere is a File Number Already Assigned to this Operation <br />Permit 4 M - (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) <br />Con plication (Rule 1.11) <br />Permit <br />1.979 -059 <br />Amendment Application (Rule 1.10) <br />(provide for Amendments and Conversions of existing permits) <br />The application for a Constructer n Materials Regular 112 Oper.rtion Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -S. Addendum 1. any sections of Exh,bit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When }ou <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 desci ibed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />Applicant/operator or company name (name to be used on hermit) Coulson Excavating Company, Inc. <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />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 Pel mit at ea <br />Brownwood Pit <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Comersion to 112 operation (set by statute) <br />�. Primary commoditie(s) to be mined: SAND GRAVEL <br />5.1 Incidental commoditie(s) to be mined: I. <br />3. - lbs/Tons r 4. <br />5.2 Anticipated end use of primary commoditie(s) to be mined <br />5.3 Anticipated end u -e of incidental commoditie(s) to be mined <br />I bs/Tons- yr <br />2 <br />lbstTonsivr 5. __ <br />Construction Materials <br />✓ Compliance <br />✓ NO Violations <br />148.7 <br />9.2 <br />157.9 <br />permitted acres <br />acres <br />acres <br />52.696.00 application fee <br />53.3-12.00 quarry application <br />52.229.00 amendment fee <br />52.696-00 conversion fee <br />lbs/Tonstvr <br />lbsfFons/vi <br />