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f PON STATE OF COLORADO <br /> DIVISION OF RF' Y <br /> Department of <br /> 1313 Sh RECEIVED <br /> Den, G COLORADO <br /> D IV n O I�rd OCT 0 3 2018 RS I ON Of <br /> EC tLAMATION <br /> MINING <br /> DIVISION OF RECLAMATION SAFETY <br /> MINING AND SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)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 /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> Permit# M - 0/ -.C61 - (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 1/2" 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 form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided,ALL information requested below. <br /> 1. Annlicant/onerator or comnany name(name to be used on nermit): Black Mountain Sand DJ, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Limited Liability Corporation (LLC) <br /> 2. Operation name(pit,mine or site name): Lost Creek, C <br /> 3. Permitted acreaee(new or existing site): —3,069.1 permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 3.2 Total acreage in Permit area —3,069.1 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 /> Industrial Sand SIC Code 1446 <br /> �. Primary commoditie(s)to be mined: <br /> Range Fran -2,400,000 Range To -4,8 ,000 <br /> �.I Incidental commoditie(s)to be mined: 1. - 00 <br /> Ibs/Tons/yr 2. / Ibs/Tons/vr <br /> 3. / Ibs/Tons/yr 4. / lbs/Tons/yr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: Industrial Sand for primary use in hydraulic fracturing <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br />