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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Departrnent of Nahrral Resources <br /> 1313 Sham=SL,Roorn 215 <br /> Denver,Colorado 60203 DIVISION O L O RA D O <br /> Phones(303)ee6-3567 C LAMATION <br /> FAX:(303)832-8106 MINING <br /> SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE:�_ There is a File Number Already Assiped to this Operation <br /> P t# M -,2iQJD--WA�(Pleaw 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 -P.Q 1 Q -QW(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) Z=Iete signed and notarized ORIGINAL and one(1) copy of the completed <br /> application farm,two(2)copies of Exhibits A-S,Addendum 1,appropriate sections of 6.5(Geotechnical Stability Exhibit,and a check far <br /> the application fee described under Section(4)below. Exhibits should 2 be bound or in a 3-ring binder;maps should be folded to <br /> 8 i/2"X 1 l"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. Appiicaut/operator or company name(name to be used on permit): Jr Q V j A fe r OrL£F.S L L G <br /> 1.1 Type of organization(corporation,partnership,etc.): /�/+ <br /> 2. Operatiou name(pit,mine or site rrarste�: Me S h da r Te lc Z O 0 <br /> 3. Permitted acrente(new or existine site): 9 99 permitted acres <br /> 3.1 Change in acreage(+) 21, 9 5* acres <br /> 3.2 Total acreage in Permit area acres <br /> 4. Fes: <br /> 4.1 New Application $2,696.00 application fee <br /> 4.2 New Quarry Application S3342.00 quarry application <br /> 4.4 Amendment Fee S2.229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2.696.00 conversion fee <br /> S. primary commodities)jq kt lam: ��p_� G fa ye W <br /> 5.I Incidental commodities}to be mined: 1. - lbs/tonsJvr 2. ! Ibs/I'orrs/vr <br /> 3. / 1bs/Tons/vr 4. / 16slrons/vr 5. / Ibs/I'ons/vr <br /> 5.2 Anticipated end use of primary commodities)to be mined:C o r%A TY'u a &r7i 4ae2�rAQ4 4e.5 <br /> 5.3 Anticipated end use of incidental commodities)to be mined: <br /> G�o�o�tb <br />