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/SOO <br /> STATE OF : <br /> DIVISION OF MINERALS AND GEOLOGY 1` <br /> Department of Natural Resources <br /> 1313 Sherman S.,Room 215 <br /> Denver,Colorado 80203 FEB 2 7 1996 <br /> Phone:B0318640567 <br /> FAX (303)832-f:106 7" <br /> MENT OF <br /> plvt5lon of M111 is NATURAL <br /> CONSTRUCTION MATERIALS RESOURCES <br /> REGUUM OPERATION (112) <br /> Roy Romer <br /> RECLAMATION PSRNIT APPLICATION FORM Governor <br /> James S.Lochhead <br /> Executive Director <br /> Michael B.Long <br /> Division Director <br /> CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br /> X_ Conversion Application (Rule 1.11) <br /> Permit f M - 87 -088 - (provide for Amendments and Conversions of <br /> existing permits) <br /> The application: for a Regular 112 operation Reclamation Permit contains three major parts: (1) <br /> the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical <br /> Stability Exhibit; and (3) the application fee. When you submit your application, be sure to <br /> include one (1) ggmplete sianed and pota,pized IVOgX ORIGINAL and four (4) copies of the completed <br /> j.=ry application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 <br /> (Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) <br /> below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br /> or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and <br /> order described in this form. <br /> sslasasssssssssasassssslsssassssassssssasssssssssssssssaxx�ce:=a=ssasaossssssss:saerssarss�=aye <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly in the space provided the information requested below. <br /> Z!i!!!!ZZ!!i!ltiZZr!!!itZZZZ!!!iZlsZZ!!Z!ZllZZZiZZ!!llZrrrtZSZtS/ZZZZZCf IZlIZZZlsZIiZZSZRIZiZa <br /> 1. AVRl cant/operator or company name (name to be used on permit): <br /> Ted R. Hubbs Family Trust, Barbara H11hIlG T t,Gtep <br /> 1.1 Type of organization (corporation, partnership, etc.): Trust <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: 33— 1 11 <br /> 853 <br /> 2. Operation naafi (pit, mine or site nams): Hubbs Pit <br /> 3. Permitted acreage, (new or existing site) 9.9 permitted acres <br /> 3.1 Change in acreage (t-or -) 28.9.3 acres <br /> 81 <br /> 3.2 Total acreage in Permit area acres <br /> 4. ees: <br /> 4.1 New Application S1.875.00 application fee <br /> 4.2 New Quarry Application S2,325.00 quarry application <br /> 4.3 Killing Application (Non-DMO) S3.100 00 milling application <br /> 4.4 Amendment Fee g1.550.00 amendment fee <br /> 4.5 Conversion to lit operation (set by statute) S1,50 .00 conversion fee <br /> S. Primary commoditiels) to be mined: Graypl <br /> 5.1 Incidental commodities) to be mined: 1. - lbs/Tons/vr <br /> 2. / hoIions/yr 3. / lbs/Tons/yr <br /> 4. lbs/Tons/vr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commodities) to be mined: Road construction <br /> 5.3 Anticipated end use of incidental commodities) to be mined: <br /> 1 <br />