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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 C O L O R A D O <br /> D r V 1 S! O N Of <br /> Phone:(303)8663567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> LUMITED LN1PACT OPERATION(110(2)) <br /> SAFETY <br /> RECLAMATION PERT I T <br /> APPLICATION FORM <br /> CHECK ONE: ® New Application(Rule 1.4} ;� Conversion Application(Rule 1.11) <br /> Permit 4 M-2016 _081 (provide for conversions of existing permits) <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)signed and <br /> notarized 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;maps should be folded to 8 1/2"X 1 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 /> l. Applicant/operator or company name(name to be used on the peanut): 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. Permitted acreage(new or existing site): 9.9 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $1 00066.,0_0 application fee <br /> 4.2 Amendment Application(from 1.10(2)) <br /> 4.3 Conversion Fee(from l 10d to 110(2),(Rule 1.11.2(2)) $1.725.00 conversion fee <br /> 5. Primary commodities)to be mined Gold, Rare Earth Elements, Niobium <br /> 6. Name of owner to the surface of affected land: Colorado State Land Board <br /> 7. Name of owner to the subsurface rights of affected land: Colorado State Land Board <br /> 8. _Type of mining operation: 21 Surface 0 Underground El In-situ <br /> Office of Office of <br /> Mined Laird Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />