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A <br /> STAT F COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 C O L O R A D O <br /> Denver,Colorado 567 CONSTRUCTION MATERIALS DIVISION O s <br /> Phone (303)866 3567 RECLAMATION <br /> FAX:(303)832-8106 REGULAR(112)OPERATION MINING <br /> RECLAMATION PERMIT APPLICATION FORM SAFETY <br /> Bill Ricer,Jr. <br /> CHECK ONE: ✓Z There is a File Number Already Assigned to this Operation Governor <br /> 1,978 210 112c Harris D.Sherman <br /> P M - ' - _ (Please reference the file number currently assigned to this operatioa):ecutive Director <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) Ronne W.Cacanp <br /> Division Directix <br /> Conversion Application(Rule 1.11) Natural Resource Trustee <br /> Permit# M -1978 21 (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)comvlete 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,ALL information requested below. <br /> 1. Applicantloverator or company name(name to be used on permit): Weld County Public Works <br /> 1.1 Type of organization(corporation,partnership,etc.): County government <br /> 2. Operation name(pit,mine or site name): Geisert Pit <br /> 3. Permitted acreaee(new or eristinQ site),: permitted acres <br /> 3.1 Change in acreage(+) RECEIVED None acres <br /> 3.2 Total acreage in Permit area acres <br /> 4. Fees: MAR 30 Z011 <br /> 4.1 New Application $2,696.00 application fee <br /> 4.2 New Quarry Application Division of Reclamation, $3,342 00 quarry application <br /> 4.4 Amendment Fee Mining&SafetY $2 229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) SU%.00 conversion fee <br /> 5. Primary commodities)to be mined: gravel sand <br /> 5.1 Incidental commoditie(s)to be mined: 1. - lbs/Tons/vr 2. / ibs/Tonslvr <br /> 3. / lbs/Tons/vr 4. / lbs/Tons/vr 5. / lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: County road maintenance <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br /> Of rice of Office of <br /> Mined Land Reclamation Denver • Grand Junction . Durango Active and Inactive Mines <br />