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STATER9gEWIJORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 APR 21 2016 <br /> Denver,Colorado 80203 COLORADO <br /> Phone:(303)866-3567 CONSTRUCTION MATERIALbIVISION OF RECLAMATION D I V I S I O 141634 <br /> FAX:(303)832-8106 REGULAR(112)OPERATION RECLAMA <br /> MINING MINING <br /> RECLAMATION PERMIT APPLICATION FORM SAE E TY <br /> .�1a'1`� eGif?L r <br /> Bill Ritter,Jr. <br /> CHECK ONE: There is a File Number Already Assigned to this Operation /1e12 —• Governor <br /> Harris D.Sherman <br /> Permit# M - - -_ (Please reference the file number currently assigned to this operatiox);ecutive Director <br /> New Application(Rule 1.4.5) V -Amendment Application(Rule 1.10) Ronald W.Cattany <br /> Division Director <br /> Conversion Application(Rule 1.11) Natural Resource Trustee <br /> Permit# M -1999 -120 - (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): L.G. Everist, Incorporated <br /> 1.1 Type of organization(corporation,partnership,etc.): Corporation <br /> 2. Operation name(pit,mine or site name): Fort Lupton Sand and Gravel Mine <br /> 3. Permitted acreage(new or existing site): 256.0 permitted acres <br /> 3.1 Change in acreage(+) 69890 acres <br /> 3.2 Total acreage in Permit area 954.90 acres <br /> 4. Fees: <br /> 4.1 New Application S709‘110 application fee <br /> 4.2 New Quarry Application34R00 quarry application <br /> 4.4 Amendment Fee $2,229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) SWAM conversion fee <br /> 5. Primary commoditie(s)to be mined: Gravel Sand <br /> 5.1 Incidental commoditie(s)to be mined: 1. - lbs/Tons/yr 2. / lbs/Tons/yr <br /> 3, / lbs/Tons/yr 4. / lbs/Tons/yr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: Specification aggregates <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br /> AF & Report <br /> ' No Violations <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />