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STATE OF COLORADO <br /> DMSION OF RECAM1A7 W INNING ARID SAFETY <br /> Dewtnerd of Nah,ral Resources <br /> 1313 Sherman SL,Room 215 C O L O R A D O <br /> Denver,Colorado 80M D I V I S I O N O F <br /> Phone:(303)866-3567 RECLAMATION <br /> FAX:(303)832-8106 MINING N i NG <br /> INI <br /> SAFETY <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 /> Permit# M -_ (Please 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 00 -01 D - (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 foided to <br /> 8 1/2"X t 1"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,A"information requested below. <br /> I. Applicant/operstor or company name(name to be need on permit): M((Ot'uvtt,1c E14MtX00 <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Operation name(pit.mine or site name): <br /> 3. Permitted acreage(new or existing site): Permitted acres <br /> 3.1 Change in acreage(+) _� acres <br /> 3.2 Total acreage in Permit area S-4 sates <br /> 4. Fees: <br /> 4.1 New Application $2,696.00 application fee <br /> 4.2 New Quarry Application $3,342.00 quarry application <br /> 4.4 Amendment Fee S2.229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2.6%.00 conversion fee <br /> 5. Prbuary rnmmodkie(s)to be mined: ,SAS c _ <br /> fiaCrf� <br /> 5.1 Incidental commoditie(s)to be mined: 1. l,1 I A - lbs/Tons/vr 2. / lbs/Tons/yr <br /> 3. ,J j,� I 1bsTTons6r 4. lbstTonslvr 5 lbs(Tons/vr <br /> 52 Anticipated end use of primary commodities)to be mined: <br /> 5.3 Anticipated end use of incidental oommoditie(s)to be mined: N I A <br />