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o �p <br />C14ECK ONE: <br />COLORADO <br />Division of Reclamation, <br />Mining and Safety <br />Department of Natural Resources <br />1313 Sherman Street, Room 215 <br />Denver, CO 80203 <br />M-2017-008 <br />LIMITED IMPACT OPERATION (110(1)) MAR 10 2017 <br />RECLAMATION PERMIT DIVISION OF RECLAMATION <br />APPLICATION FORM MINING & gAF <br />ETy <br />New Application <br />Permit # M- - (provide for conversions and amendments of existing permiw) <br />The apptication for a Limited Impact I 10(I) Mining Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A -J, any required sections of Exhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules 6. 1, <br />6.2, 6.3, and 6.5; and (3) the application fee. When you submit your application, be sure to include one (1) signed and notarized original <br />and one (1) copy of the application form, two (2) copies of Exhibits A -J, and 6.5 (Geotechnical Stability Exhibit), as required, and a check <br />for the application fee described under (4) below. Exhibits should not be bound or in a 3 -ring binder; maps should be folded to 8 1.2" X <br />I 1" or 8 112" 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 described below <br />I . Anplicantloyerater or company name (name to be used on the permit): LLM Investments LLC <br />1.1 Type of organization (corporation, partnership, etc.): Limited Liability Company <br />2. Operation name (nit, mine or site name): California Mine <br />3. Permitted acreaze (new or existing): (must be 5 acres or less) -5 permitted acres <br />31 <br />4. Fees: <br />4.1 New Application $288.00 application fee <br />5. Primary commoditie(s) to be mined- Crystals & Spscimans <br />6. Name of owner to the surface of affected land: LLM Investments LLC <br />7. Name of owner to the subsurface rights of affected land: LLM Investments LLC <br />8. Type of mining operation: _a Surface ,a Clndergmund F lacer <br />1313 Sherman Street, Room 215, Denver, CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us I <br />