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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources <br /> JLE WHE Hand-delivered <br /> 1313 Sherman St.,Room 215 M-1995-017 AR01 <br /> Denver,Colorado 80203 4 Annual Fee/Report: CW D DIVISION Of iv <br /> C O L O R A D O <br /> Phone:(303)866-3567 Violations RECLAMATION <br /> FAX:(303)832-8106 MV2004012 2/23/2004 AB 4/22/2004 MINING <br /> MV2006009 5/10/2006 AB 5/31/2006 _&— <br /> MV2016018 3/9/2016 VA 3/11/2016 SAFETY <br /> CONSTRUCTION MATERIALS <br /> LIMITED IMPACT(I 10)OPERATION RECEIVED <br /> RECLAMATION PERMIT APPLICATION FORM APR 17 2017 <br /> CHECK ONE: a There is a File Number Already Assigned to this Operation DIVISION OF RECLAMATION <br /> Permit# 1*95 017 - MINING AND SAFETY <br /> (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> Permit# M - 1995 017 (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Limited Impact (1 10) Operation Reclamation Permit contains three major parts: (1) the <br /> application form:(2)Exhibits A-J,Exhibit L,Addendum 1,any sections of Exhibit 6.5 and Geotechnical Stability Exhibit,as required by <br /> the Office,and outlined in Rules 6.1,6.2,6.3.6.5.and 1.6.20)(b):and(3)the application fee. When you submit your application,be sure <br /> to include one(1)complete signed and notarized ORIGINAL and one(1)copy of the completed application form, two(2)copies of <br /> Exhibits A-J, Exhibit L. Addendum 1.and appropriate sections of 6.5 (Geotechnical Stability Exhibit),as required,and a check for the <br /> 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 I I"or 8 <br /> 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 described below. <br /> I. Applicant/operator or company name(name to be used on permit): Donald Saling, City of Sterling <br /> 1.1 Type of organization(corporation,partnership,etc.): Municipality <br /> 2. Operation name(pit,mine or site name): Rothe Sand and Gravel Pit <br /> 3. Permitted acreage(new or existing site): 9.95 permitted acres <br /> 3.1 Change in acreage(+) 0 acres <br /> 3.2 Total Acreage in Permit Area 9.95 acres <br /> 4. Fees: <br /> 4.1 New Application: $1258.00 application fee <br /> Amendment Fee(C.R.S. 34-32.5-125(ll)): $827.00 application fee <br /> 5. Primary commodities)to be mined: Sand Gravel <br /> 5.1 Incidental commoditie(s)to be mined: 1. Ibs/Tons/vr 2. Ibs/Tons/yr 3. Ibs/Tons/yr <br /> 4. Ibs/Tons/yr 5. Ibs/Tons%yr <br /> 5.2 Anticipated end use of primary commodities)to be mined: Base for recreational trails both on-site and off-site <br /> Anticipated end use of incidental commoditie(s)to be mined: N/A <br />