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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman $L, Room 215 <br />COLORADO <br />Denver, Colorado 80203 <br />D I v I s 1 o N o f <br />Phone: (3031866.3567 <br />RECLAMATION <br />FAX (303) 632-8106 <br />MINING <br />— <br />SAFETY <br />CONSTRUCTION MATERIALS <br />91t1 Rtttc , It. <br />SPECIAL (111) OPERATION <br />Covemor <br />Flarrls D. 511emran <br />RECLAMATION PERMIT APPLICATION FORM <br />Erzetutive Director <br />Ronald W. Canary <br />Division Direcwr <br />Natural Resource Trustee <br />The application for a Construction Materials Special III Operation Reclamation Permit contains fourma3or parts: (1) the application form; <br />(2) Exhibits A -L, Addendum 1, and any sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b), (3) the application fee; (4) the Performance Warranty and if required a Financial Warranty. When <br />you submit your application, be sure to include one (1) completed, signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as <br />required, a check for the application fee described under (4) below, and the fully executed Performance Warranty and Financial Warranty, if <br />required. Exhibits should NOT be bound or in 3 -ring binders; maps shoved be folded to 8 2" X 1 V or 8 2" X 14" size. To expedite <br />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 />3. Aonlicantloyerator or company name (name to be used on the permit): <br />Castle Rock <br />1.1 Type of organization (corporation, partnership, etc.): Partnersh i. p <br />2. Operation name (nit, mine or site name): VICK BORROW PIT <br />3. Permitted acreage: 1 0_ j 5 Permitted Acres <br />4. New Apnfication: S898.00 Application Fee <br />5. Primary commodities to be mined: <br />6. Name ofownertothe surface oraffectedland.. Anthony _& Stacy',. V1Gk <br />7. Name of owner to the subsurface rights of affected land: Anthony- _ Vick <br />8. Tvne of mining overation: iR Surface II Underground n In-situ <br />9. Location information: The center of the area where the majority ormining will occur <br />COUi <br />PRINCIPAL MERIDIAN (chick one) MJA62th (Co)orado) IOth (New Mexico) f] Ute <br />SECTION (write number). S 3— <br />TOWNSHIP (write number and check direction). T 1 1 North South <br />RANGE (write number and check direction). R East West <br />QUARTER SECTION (check one). NE NW SESW <br />QUARTERIQUARTER SECTION (check one): NE NW SE E SW <br />GENERAL DESCRIPTION: (thc number of miles and direction from the nearest town and the approximate elevation). . <br />Office of Office of <br />Mtned Land Reclamation Denver • Grand Junction • Durango Aclive and Inactive Mines <br />