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� STATE OF COLORADO <br /> w <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources RECEIVED <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 C O L O RA D O <br /> Phone:(303)866-3567 OCT 13 2016 DIVISION o f <br /> RECLAMATION <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:EEL There is a File Number Already Assigned to this Operation <br /> Permit# M - d,4 A' -IMI(Please reference the file number currently assigned to this operation) <br /> FNew Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> C'N PL— ML Conversion Application(Rule 1.11) <br /> Permit# M - 21ye;tz_-O! Q(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 of6.5(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 11"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. AyChcaut/operator or company name(name to be used on permit): h geib- &e <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Operation name(pit,mine or site name): &,ce A mr�e/e r 1p%/ <br /> 3. Permitted acrea¢e(new or eaistine site): �T ,�•42 permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 3.2 Total acreage in Permit area 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: r-a <br /> 5.1 Incidental commodities)to be mined: 1. lbs/Tons/yr 2. / lbs/Tons/vr <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: //f� <br /> 5.3 Anticipated end use of incidental commodities)to be mined: <br /> �l Annual Fee and Report-CW <br /> �1 Violations: <br /> MV-2016-036 6/22/2016 <br /> AB 8/4/2016 <br />