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STATE OF COLORADO <br />DMSION 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 />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />DIVLSION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />CHECK ONE: I _ t There is a File Number Already Assigned to this Operation <br />Permit # 116 102 -_ (Please reference 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 />Permit # M <br />1 cJ86- 10"L _ (provide for Amendments and Conversions of existing permits) <br />- <br />Cons <br />t (110) <br />peration <br />ation <br />t contains <br />e major parts: (1) the <br />The application <br />for a iA-J, Materials L, Addendum 1, any secctioOns of Exhibit 6.5 and Geotechnical rSt bili eExhibit as required by <br />Office, <br />form; (2) Exhibits 6.1, 6. <br />the e, one (1) complete <br />l Rulessed1, 6 and n and RIGINAL and one (l) copy of the completed applicaen you tion formit your , two (2) copies of <br />toplication, be sure <br />include one Obomplete srRrr <br />Exhibits A -J, Exhibit I,, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability , PS r�o�d be required, ded o 81/2'eck X 11" rthe <br />or 8 <br />application fee described under (4) below. Exhibits should NOT be bound or in a 3 -ring <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. Applicant/operator or company name (name to be used on permit): <br />Dan Collins / Collins -Morehead, LLC <br />1.1 Type of organization (corporation, partnership, etc.): Limited Liability Partnership <br />2. Operation name (pit, mine or site name): Deep Creek Placer 2.0 permitted acres <br />3. Permitted acreage (new or existing site): acres <br />3.1 Change in acreage CO <br />acres <br />3.2 Total Acreage in Permit Area <br />4. Fees: $1258.00 application fee <br />4.1 New Application: $827.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(11)): <br />5. Primary commoditie(s) to be mined: NIA Ibs/Tons/ti r <br />5.1 Incidental commoditie(s) to be mined: 1. NIA / lbs/Tonsh'r 2. / Ibs/Tons/vr 3. / <br />4. / lbs/Tons/z 5. / Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: N/AN/A <br />Anticipated end use of incidental commoditie(s) to be mined: <br />