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STATE OF COLORADO <br /> WSION OF MC All AMN,WNING AND SAFETY RECEIVED <br /> Department of Natural Resources <br /> 1313 Sherman St,Room 215 C C L O 4 A C O <br /> Denver,Colorado 80203 NOV 2 3 2016 u IV s i ON o e <br /> AMATION <br /> Phone:(303)866-3567 v RECL <br /> FAX:(303)832-8106 MINING <br /> DIVISION OF RECLAMATION —&— <br /> MINING AND SAFETY SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: There is a F'de 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 IJ0) <br /> Conversion Application(Rule 1.11) , Adequacy Review Response <br /> Permit# M <br /> $- g t (provide for Amendments and Conversions of existing permits) <br /> - e _tJ - <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 paint clearly,in the space provided,ALL information requested below. <br /> Vr A"i�� K <br /> 1. Appikant/onerator or comt►anv name(name to be used on®ermit): 1 a f.(0�'� �,��a . ^ �Ya�� a <br /> 1.1 Type of organization(corporation,partnership,etc.): S V"a <br /> 2. Operation name(Bit.mine or site name): <br /> 3. Permitted acreage(new or existing site): C� _ permitted acres <br /> 3.1 Change in acreage(+) _ acres <br /> 3.2 Total acreage in Permit area s acres <br /> 4. Fees: <br /> 4.1 New Application j2.b96.00 application fee <br /> 2 New Quarry Application $3.342A0 quarry application <br /> 4. <br /> 4. Amendment Fee $2.229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2 696A0 conversion fee <br /> 5. Primary contmoditie(sl to be mined: �____ <br /> 5.1 Incidental commodities)to be mined: 1. PJ E A. lbs/Tons/vr 2. 1 lbs/1 ons/yr <br /> 3. f . / 1bs/Tons/vr 4. �'f-e / Ibs/Toms/vr 5.. t i / tbslTonslyr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: fN = t= a°—; °� `a s' U - <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: e'bl s <br />