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COLORADO <br />Division of Reclamation, <br />Av- Mining and Safety <br />Department or Natural Resources <br />1313 Sherman Street, Room 215 <br />Denver, CO 80203 <br />Date: -TwA A ZOO, <br />RE. Need for State Reclantation Permit. "Is It Mining?" <br />Name: 5a' %r%y�c���c•c ��rc <br />Mailing Address: City: State: <br />Telephone: �)�•_. Cell: �) - <br />Email: <br />- <br />Zip Code: <br />Enclosed are pertinent sections of the Colorado Mined Land Reclamation Board (Board) Rules governing <br />activities that do not require a reclamation permit. To determine if you need a permit for you proposed <br />activity, first check Rule 1.2 which describes activities the Board has determined do not require state <br />reclamation permits. If you find a match, you can proceed based on your interpretation of the rule, but at <br />your own risk. If you are uncertain how the Rule may apply to your activity, you should answer the list of <br />questions below with as much detail as possible. Please feel free to use additional paper, maps, and <br />attachments to explain your project. <br />Please include in your determination request answers to the following questions: <br />Please provide the legal location of the proposed project and submit a site map that clearly <br />delineates the location of the proposed extraction site and the location of the nearest city, town, <br />and county location name. <br />Section _ ;Township ;Range ;PM_ County <br />Or NAD27 GPS X UTM Y UTM <br />Direction and miles to nearest town/city <br />2. Is the site of material extraction on public or privately owned property? <br />3. What type(s) of material or metal is. -are proposed to be extracted and describe the physical nature <br />of the site i.e., river terrace, rocky knob, in -stream gravel deposit, etc.? <br />4. What processing or extraction method(s) will be used on site? Include any equipment or <br />chemical(s) that will be used in the processing and extraction of the materials. <br />5. Will the extracted material be hauled offsite or used on the same parcel of property where the <br />material is extracted? <br />6. How will the extracted material be used on site? <br />7. If the material is hauled offsite, where will it be hauled to and what it the intended use? <br />1313 Sherman Street, Room 215, Denver, Co 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us <br />John W. Hickentooper, Governor I Mike King, Executive Director I Virginia Brannon, Director <br />