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i <br /> STATE OF COLORA ro <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources RECEIVED <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 Cp �t C tRUCLAMATION <br /> O RA D O <br /> Phone:(303)866-3567 SE f 9 2016 t o N or <br /> FAX:(303)832-8106 DIVISION OF RECLAMATION NING <br /> MINING AND SAFETY 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# MUM 024 -� (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) 0—Amendment Application(Rule 1,10) <br /> A{nnC� 0—Conversion Application(Rule 1.11) <br /> Permit# M 2003 Q24 (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 ofExhibits A-S,Addendum 1,appropriate sections of 6.5(Geotechnical Stability Exhibit,and acheck 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,ALL information requested below. <br /> I. Applicant/operator or company name name to be used on permit): Phillips County _ <br /> 1.1 Type of organization(corporation,partnership,etc.): Government - ^� <br /> 2. Operation name(pit,mine or site name): Ward Pit <br /> 3. Permitted acreage(new or existing site): 19.8 permitted acres <br /> 3.1 Change in acreage(+) 10.2 acres <br /> 3.2 Total acreage in Permit area 30.0 acres <br /> 4. Fees: <br /> 4.1 New Application $2.696.00 application fee <br /> 4.2 New Quarry Application 53,342.00 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 /> i Gravel Sand <br /> 5. Primary commoditie(s)to be mined: <br /> 5.1 Incidental commoditie(s)to be mined: l._ NA - Ibs/Tons/yr 2. / lbs/Tons/yr £RR <br /> 3._ / lbs/Tons/yr 4. / Ibs/Tons/yr 5. / lbs/Tons/ <br /> 5.2 Anticipated end use of primary commodities)to be mined: 90,4a Base Mc,'f <br /> 5.3 Anticipated end use of incidental commodities)to be mined: -NA <br /> A <br /> Annual Fee and report-CW. <br /> �1 No Violations <br />