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RECEIVED <br /> Mai 2 o Zook �rr-A- -rE OF COLORADO _ <br /> DIVISION OF MINERALS AND GEOL&W o ��� Illllllllllli III <br /> Deoartment of Natutal Resources l398 <br /> 13 T 3 Sherman St..Room 215 <br /> Denver,Colorado 80203 D t v t s l o tv o <br /> Phone:(303)866.3567 CONSTRUCTION MATERIALS M I N E RA L S ' <br /> FAX.(303)832-8106 REGULAR(112)OPERATION & <br /> GEOLOGY <br /> RECLAMATION PERMIT APPLICATION FORM R E C L A M A T 1 0 rt <br /> MINING-SAFETY <br /> Bill Owens <br /> Governor <br /> CLICK ONE: There is a File Number Already Assigned to this Operation Greg E.Watcher <br /> Permit# M - - (Please reference the file number currently assigned to this operation) Executive Director <br /> Michael B.tong <br /> X_New Application(Rule 1.4.5) Amendment Application(Rule 1.10) Division Director <br /> Conversion Application(Rule 1.11) <br /> Permit# M - (provide for Amendments and Conversions of existing permits) <br /> 4 <br /> The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts:(1)the application form: <br /> (2)Exhibits A-S,Addendum 1,any sections of Exhibit 6.5(Geotechnical Stability Exhibit;and(3)the application fee. When you submit your <br /> application,be sure to include one(1)` le p sigped and no ed NORY ORIGINAL and four(4)copies of the completed jai <br /> application form,five(5)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 I/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 described below. <br /> I. Applicant/operator or company name name to be used on permit): <br /> T..nygland Ready mix Concrete. Inc. <br /> 1.1 Type of organization(corporation,partnership,etc.): Corporation <br /> 1.2 I.R.S.Tax I.D.No.or Social Security Number: <br /> 2. Operation name(pit-mice or site name): vreen/Croissant Property Sand and Gravel Mine <br /> 3. Permitted acreage(new or existine aim): 210 permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 3.2 Total acreage in Permit area 210 acres <br /> 4. Fees: <br /> 4.1 New Application S2.344.00 application fee <br /> 4.2 New Quarry Application S23906.00 quarry application <br /> 4.4 Amendment Fee S 1.938.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2,344.00 conversion fee <br /> (, 5. rimary commodWe(sl to be mined: S D 6 <br /> 5 1 Incidental commodiue(s)to be mined: 1. / lbslTondyr 2. / 1bsrTons/vr 3. / lb onstvr <br /> 4. / 1bslTon 5. / lbsnons/vr <br /> 5.2 Anticipated end use of primary commodities)to be mined: <br /> 5.3 Anticipated end use of incidental commodities)to be mined: <br />