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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) 868-3567 <br />FAX (303) 832-8106 <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />DIVISION Of <br />RECLAMATION <br />MINING <br />—&— <br />SAFETY <br />CHECK ONE: ❑ There Is a File Number Already Assigned to this Operation RECEIVED <br />Permit N M _ (Please reference the file number currently assigned to this operation <br />New Application (Rule 1.4.5) fa Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) MAR 212016 <br />Permit # M -dolt, -v1 ,lj - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three majorPIN A„^ ETapplication foam; (2) Exhibits A -J, Exhibit L, Addendum 1, any sections of Exhibit 6 5 and Geotechnical Stability Exhibit, as r /V,Y G, , <br />the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When you submit your app Ituttion, be sure <br />to include one (1) complete sired and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of <br />Exhibits A -J, Exhibit L, Addendum 1, and appropriate sections of 6 5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described under (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps should be folded to 8 1/2" X II" or 8 <br />1/2" X 14" size. To expedite processing, please provide the information in the format and order descnbed in this form <br />OF RECLAMATION <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL Information described below. <br />I. Applicant/operator or company name (name to be used on permit2' /- U C k V Q U A s R y <br />1.1 Type of organization (corporation, partnership, etc.): Lt ( ) <br />2 Operation name (nit, mine or site name)' is u (' h L 1-) t.t t) f np" Ode I , 5 hd rp Lceri- <br />3 Permitted acreage (new or existing site). <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Permit Area <br />q , S acres <br />4. Egg: <br />4.1 New Application' $1258.00 application fec <br />Amendment Fee (C.R.S. 34-32 5-125(1I)). 5827.00 application fee <br />5. primart commodities) to be mined: Rem 3/e eA)A-,(' / rr Reck <br />5.1 Incidental commOditie(s) to be mined. I. OP / e Olbs/Tons/vr 2. / Ibs/Tons/vr 3 / lbs/Tons/yr <br />4. / Ibs/Tons/vr 5. / Ibs/Tons/vr <br />5.2 Anticipated end use of primary commodities) to be mined' 490 L// <br />Anticipated end use of incidental commodrtie(s) to be mined: 90 L// <br />permitted acres <br />