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STATE nF CnLORADO <br /> DIVISION OF WLAMATiON,MININ( M-2016-081 CN01 <br /> D"rtmentof Natural Resources Annual Fee/Report: 0 <br /> Denver, <br /> r,C&n do Room 215 No Violations C O L D RA D O <br /> Denver,Cobrddo 80293SION Of <br /> Phorw(303)866.3'567 ACY G R M REC DIVtLAMATION <br /> FAX:(303)832-8106 MINING <br /> LIMITED IMPACT OPERATION(110(2)) <br /> SAFETY <br /> RECLAMATION PERMIT <br /> APPLICATION FORM RECEIVED <br /> APR 10 2017 <br /> CHECK ONE 0 New Application(Rule 1.4) JZL Conversion Application(Rule 1.11) <br /> DIW3ION OF RECLAMATION <br /> Permit#M-M 081-ACY (provide for conversions of existing permits) MNNG AND SAFETY <br /> The application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (1)the application <br /> form; (2)Exhibits A-J,any required sections of Exhibit S and Geotechnical Stability Exhibit,as required by the Office,and outlined in <br /> Rules 6.1,6.2,6.3,6.4.19 and 6.5;and(3)the application fee. When you submit your application,be sure to include one(1)sigzr an <br /> original and one(1)copy of the application form,two(2)copies of Exhibits A-J,appropriate sections of 6.4.19 Exhibit S and 6.5 <br /> (Geotechnical Stability Exhibit),as required,and a check for the application fee described under(4)below.Exhibits should not be bound <br /> or in a 3-ring binder;malls should be folded to 8 1/2"X I l"or 8 1/2"X 14"size. To expedite processing,please provide the information <br /> 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 /> 1. Applicant/operator or company name(name to be used on the permit): Au Pt Industries LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Limited Liability Company <br /> 2. Operation name(pit,mine or site name): West Side Placer <br /> 3. Perwitted acreage(new or existing site): 9.9 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $1,006.00 application fee <br /> 4.2 Amendment Application(from 1.10(2)) <br /> 4.3 Conversion Fee(from I10d to I10(2),(Rule 1.11.2(2)) $1.725.00 conversion fee <br /> 5. Primary commoditie(s)tobemined: Gold, Rare Earth Elements, Niobium <br /> 6. dame of owner to the surface of affected land: Colorado State Land Board <br /> 7. Name of owner to the subsurface rllobts of affected land: Colorado State Land Board <br /> 8. Type a of mining operation: Surface 1:1Underground Z In-situ <br /> Office of Office of <br /> Mined land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />