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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 <br />COLORADO <br />Phone: (303) 8663567 <br />AMRE <br />DIV [ S l O N O F <br />RECLAMATION <br />FAX. (303) 832-8106 <br />02 <br />MINING <br />SAFETY <br />CONSTRUCTION MATERIALS Ck':./ <br />REGULAR (112) OPERATION V <br />ED <br />RECLAMATION PERMIT APPLICATION FORM ocr0 <br />�f <br />CHEJ ONE: II— There is a File Number Already Assigned to this OperationMSN NOF1 <br />NGRNDs4p� <br />Permit # M - - (Please reference the file number currently assigned to this operation) <br />HNew Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />:: Conversion Application (Rule ].11) <br />Permit #- (provide for Amendments and Conversions of existing permits) <br />3 <br />co 0 <br />AMIN AS .01 <br />The application for a ( onstruction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the applicati( <br />10 <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When yc o � <br />be include <br />coo <br />submit your application, sure to one (1) complete signed and notarized ORIGINAL and one (1) copy of the com lett — <br />a <br />application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check f, �' <br />the fee described 4i <br />b <br />application under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded t <br />8 ]r2" X I I" or 8 1;'2" X 14" size. To expedite processing, please provide the information in the format and order described in this forn <br />j <br />�l <br />m <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />I . Applicant/operator or company name (name to be used on permit): Oldcasle SW Group, Inc. dba United Companie z <br />1.1 Type of organization (corporation, partnership, etc.): Corporation 0 <br />b <br />0 <br />0 <br />> <br />2, Operation name it mine or site name), Rozman Mix Pit <br />o <br />_ <br />.3. Permitted acreage (new or existine site): 59 permitted acres lD <br />n• <br />3.1 Change in acreage ( 1 ) 0 acres <br />3.2 Total acreage in Permit area 59 acres <br />4. Fees: <br />4.1 New Application $2,696.00 application fee <br />4.2 New Quarry Application $3,342.00 quarry application <br />4.4 Amendment Fee $2,229.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2,696.00 conversion fee <br />5. Primary commoditie(s) to be mined: Sand gravel <br />5.1 Incidental commoditie(s) to be mined: 1. — - lbsrTons/vr 2. lbs/Tons/yr <br />3. lbs/Tons/yr 4. lbs/Tons.-'Yr 5. lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined. Construction materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined-. <br />