2016-01-22_REVISION - M1986102

• Permit No: M1986102
• IBM Index Class Name: REVISION
• Doc Date: 1/22/2016
• Doc Name: Application AM01
• From: Dan Collins / Collins-More-head, LLC
• To: DRMS
• Type & Sequence: AM1
• Email Name: LJW
• Email Name: GRM
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION OF RECLAMATION, MINING AND SAFETY
Department of Natural Resources
1313 Sherman St., Room 215
Denver, Colorado 80203
Phone. [phone]
FAX: [phone]
RECEIVED
JAN 2 2 2016
DMMMSION OF RECLAMATION
CONSTRUCTION MATERIALSNING AND SAFETY
A Q i
CU l!
V 0 Violations
LIMITED IMPACT (110) OPERATION
RECLAMATION PERMIT APPLICATION FORM
CHECK ONE: 1 There is a File Number Already Assigned to this Operation
Permit # 1386 102 - (Please reference the file number currently assigned to this operation)
New Application (Rule 1.4.5) Amendment Application (Rule 1.10)
Conversion Application (Rule 1.11)
Permit # M _ 1986- 102 - (provide for Amendments and Conversions of existing permits)
COLORADO
DIVISION OF
RECLAMATION
MINING
—&—
SAFETY
The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the
application form; (2) Exhibits A -J, Exhibit L, Addendum 1, any 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 submit your application, be sure
to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of
Exhibits A -J, 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 NOT be bound or in a 3 -ring binder; maps should be folded to 81/2" 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.
GENERAL OPERATION INFORMATION
Type or print dearly, in the space provided, ALL information described below.
Applicant/operator or company name (name to be used on permit): Dan Collins / Collins -Morehead, LLC
1.1 Type of organization (corporation, partnership, etc.): Limited Liability Partnership
2. Operation name (pit, mine or site name): Deep Creek Placer
3. Permitted acreage (new or existing site): 2.0 permitted acres
3.1 Change m acreage (+) acres
3.2 Total Acreage in Permit Area acres
4. Fees:
4.1 New Application: $1258.00 application fee
Amendment Fee (C.R.S. 34-32.5-125(1I)): $827.00 application fee
5. Primary commoditie(s) to be mined: N/A
5.1 Incidental commoditie(s) to be mined: 1. NIA / lbs/Tons/yr 2. / lbs/Tons/vr 3. / lbs/Tons/yr
4. / lbs/Tons/yr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: N/A
Anticipated end use of incidental commoditie(s) to be mined:
N/A