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. - ,# 1111«1�11�t11111�1 <br /> � 999 <br /> STATE OF COLORADO <br /> DIVISION OF MINERALS AND GEOLOGY RECEIVED <br /> Dr w <br /> patlment ui Nan Lr <br /> 1 hrnqurces f1 <br /> 111 S Sherman St,Room 215 04 <br /> Denver,Colorado B02U3 JAN 0 8 200t c I v r s 1 o N o r <br /> Phone.(3U.t1 IJ66-35b: M IN ERA I-S <br /> FAX•003)832.8106 & + <br /> Division of Minerals and Geology G E O L O G ) ; <br /> RECLAMATIONr <br /> CONSTRUCTION MATERIALS MINING•SAFETY I <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM 8,11 Owens <br /> Governor <br /> CreR E Walcher <br /> Executive Direr-tor <br /> CHECK ONE: +ichael 8 Long <br /> __C New Application(Rule 1.4.5) Amendment Application(Rule I.1 Ovivrsaion Director <br /> Conversion Application(Rule 1.11) <br /> 2W-00f <br /> Permit ih 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 form; <br /> (2)Exhibits A-S,Addendum I,any sections of Exhibit 6.5(Geotechnical Stability Exhibit;and(3)the application fee. When you submit your <br /> application, be sure to include one(1) com2lete signed and notarized IVQRY ORIGINAL and four(4)copies of the completed Ivory <br /> application form,five(5)copies of Exhibits A-S,Addendum 1,appropriate sections of 6.5(Geoteehnical 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 1/2"X l 1"or 8 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 requested below. <br /> I. A Iicant/opers-tor or company name(name to be used on Permit): vr• AGn wt& � <br /> 1.1 Type of organization(corporation,partnership,etc.): Ljrnt� LSa6i L cArrtp <br /> 1.2 I.R.S.Tax I.D.No.or Social Security Number: ELOC— �54i-1l <br /> 2. Operation name(pit,mine or site atme): U NE CAMI? -PtT <br /> 3. Permitted acreage(new or existing site): 8,q permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 3.2 Total acreage in Permit area acres <br /> 4. Fees: <br /> 4.1 New Application S1.875.00 application fee <br /> 4.2 New Quarry Application $2.325.00 quarry application <br /> 4.3 Milling Application(Non-DMO) SJ,100.00 milling application <br /> 4.4 Amendment Fee S1.550.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) S1,875.00 conversion fee <br /> 5. Primary commoditle(s)to be mined: Sa1'xi Ord -- <br /> 5.1 Incidental commoditie(s)to be mined: 1. lbst7ons/yr 2. / 1bsfTonS/vr <br /> 3. 1 Ibs/Tons/�j 4. / lbslPonslvr 5. _ 1 lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: cfx)'5 f l-toc� ac�Q 4g1 <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br />