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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />application fee <br />53.3.12.00_ <br />Department of Natural Resources <br />$2.22%00 <br />RECEIVED <br />$2.696.00 <br />1313 Sherman St., Room 215 <br />DMC GRM <br />O L O R A D D <br />Denver, Colorado 80203 <br />M-1991-133 AM01 <br />JUL 3 i 2011 <br />a i v r s t o o f <br />D <br />Phone: (303) 866-3567 <br />FAX. (303) 832-8105 <br />/Annual Fee/Report: CW <br />RECLAMATION <br />MINING <br />V No Violations <br />DIVISION OF RECLAMATION <br />— &— <br />MINING AND SAFETY <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: F There is a Pile Number Already Assigned to this Operation <br />Permit #vel - _ (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 I( M -�-�- (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps should be folded to <br />8 112" X I I" or 8 112" X I4" 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 requested below. <br />1. ADDlicanUoperator or company name (name to be used on permit): /'' 0P11V.S a G7/ ID <br />1.1 Type of organization (corporation, partnership, etc.): L L f <br />2. Operation name (nit, mine or site name): O f 1 f s COQ l _57 <br />C1 L <br />/CuAM,sxl-'Z-j+ kAJaW" A 5 <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (-t) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s),to,be mined: 4,1;0e-4VZZ- D <br />5.1 Incidental commoditie(s) to be mined: I. Ibs/Tons/vr <br />ArL=P P, T <br />permitted acres <br />_ / -51 9S acres <br />-f- • 5 . acres <br />52.696.00 <br />application fee <br />53.3.12.00_ <br />quarry application <br />$2.22%00 <br />amendment fee <br />$2.696.00 <br />conversion fee <br />2. Ibs/Tongyr <br />3. 1 _ _ _ IbslTonsN 4. lbs/Tons/ 5. 1 lbs/Tons/y.r <br />5.2 Anticipated end use of primary commoditie(s) to be mined: , eAi> _LLv, c'7 /aN�. n y-. r ra �cT <br />f -Ze-i vi— C c A -r'-M V L7 - e - <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Summit Engineering Job Number: 1707122CE <br />719-589-6147 <br />Alamosa, CO <br />1 <br />