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STATE OF COLORADO p <br /> DWISION OF fM%AWTlM W NNG AND SJ1 M <br /> [3"tment of Natural Resources <br /> 1313 Shmswn SL.Boom 215 A <br /> Dwww. COLORAD F <br /> Phone:(3m)866-3567 v�v{a i o H o <br /> RECLAMATION <br /> FAX:(303)832-8106 <br /> MINING <br /> SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(1 I2)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE:�, There is a File Number Already Assigned to this Operation <br /> Permit# M - - (Please reference the file number currently assigned to this operation) <br /> HNew Application(Rule 1.45) Amendment Application{Rule 1.10) <br /> ::Conversion Application(Rule 1.11) <br /> Permit# _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 ofExhibit 6.5(Geotechnicai Stability Exhibit;and(3)the application fee. When you <br /> submit your application,be sure to include one(1)cetttpkte signed and notarized ORIGINAL and one(1)copy of the completed <br /> application form,two(2)copies of Exhibits A-S,Addendum 1,approbate sections of 6.5(Geotechnical Stability Exhibit,and a check for <br /> the application fee desm-bed wader Section(4)below Exhibits should NOT be bawd or in a 3-ring binder,maps should be folded to <br /> 8 1/2'X l I"or 81/2"X 14'size. To expedite processing,please provide the infomotion in the format and order described in this form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided,AAL information requested below. <br /> I. Applicant/operator or company name(name to be used oil permit): Empire Aggregate, Inc. <br /> 1.1 Type of Organization(corporation,partnership,etc.): Limited Liability Corporation <br /> 2. Operation name(nit,mine or site name): Douglas Mountain Mine <br /> 3. Permitted acreage(new or existing site): 68•2 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 Applicafion S2.696 00 application fee <br /> 4.2 New Quarry Application $3,3442.00 quarry application <br /> 4A Amendment Fee $2,229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2.696.00 conversion fee <br /> S. Primary commoditie(s)to be mined: sand gravel <br /> S.I Incidental commoditie(s)to be mined: 1. - Ibsilons(vr 2. / Ibs/fons/yr <br /> 3. / lbs9gRgyr 4. / Ibsffonsftrc S. / Ibs/Tonslvr <br /> 5.2 Anticipated end use of primary commoduie(s)to be mined: construction materials <br /> 5.3 Anticipated end use of incidental commodities)to be mined: <br />