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# MO <br />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 / C N 01 <br />Phone: (303) 866-3567 �' <br />FAX: (303) 832-8106 *AFP /20/16) <br />E* NO VIOLATIONS <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />COLO RAI)O <br />D IV IS I ON Of <br />RECLAMATION <br />MINING <br />SAFETY <br />RECEIVED <br />MAR 7 9 2016 <br />DIVISJON OF RECtJAMAT'014 <br />M11;; i i & SAFETY <br />Permit # M - - (Please reference the file number currently assigned to this operation) <br />FNew Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -2,00q- Q ) Q - (provide for Amendments and Conversions of existing permits) <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): C O r en %iJe- �1tCAV14�ldN A�1, PAU ItA 11C <br />T- <br />1.1 Type of organization (corporation, partnership, etc.): S 'i4- <br />2. Operation name (pit, mine or site name): S kewara_ 3.1- <br />T3. <br />3. Permitted acreage (new or existing site): <br />1 0 <br />permitted acres <br />3.1 <br />Change in acreage (+) <br />t acres <br />3.2 <br />Total acreage in Permit area <br />Sj <br />acres <br />4. Fees: <br />4.1 <br />New Application <br />$2,696.00 <br />application fee <br />4.2 <br />New Quarry Application <br />$3,342.00 <br />quarry application <br />4.4 <br />Amendment Fee <br />$2.229.00 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />$2,696.00 <br />conversion fee <br />5. Primary commoditie(s) to be mined: StwlC Gt civt✓� <br />5.1 <br />Incidental commoditie(s) to be mined: I. PIA - lbs/Tons/yr 2. IV <br />/A / <br />lbs/Tons/vr <br />3. ' 1 %p / Ibsil'ons/yr 4. lbs/Tons/yr 5. <br />w1 A l <br />lbs/Tons/yr <br />5.2 <br />Anticipated end use of primary commoditie(s) to be mined: L^�n$�t�s.�kvo,� '�' I' <br />Qf' M U $V4 <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: w I <br />