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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources RECEIVED <br /> 1313 Sherman St., Room 215 4 <br /> COLORADO <br /> Denver,Colorado 80203 r�JUN 2 4 2016 D I V I S 1 0 N o f <br /> Phone:(303)866-3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> DMSION OF RECLAMATION —&— <br /> MINING AND SAFETY SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE:Fy-1 There is a File Number Already Assigned to this Operation <br /> Permit# M _Z001-017 __ (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 -2001 _017 _ (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 I I"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,ALI,information requested below. <br /> I. 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): Carbon Valley Resource <br /> 3. Permitted acreage(new or existing site): 65.0 permitted acres <br /> 3.1 Change in acreage(+) 56.4 acres <br /> 3.2 Total acreage in Permit area 121.4 acres <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 $2,229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2,696.00 conversion fee <br /> 5. Primary commoditie(s) to be mined: <br /> sand gravel <br /> 5.1 Incidental commoditie(s)to be mined: I. n/a - 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: construction aggregates <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: n/a <br /> Annual Fee/Report CW 2 <br /> No Violations <br />