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-- STATE OF COLORADO <br /> DIVISION OF REGI_"ih'ilv,TiON, NNNNG'�A,ND,.'%FEZ Y <br /> Department of Natural h &GE!rG S RreEIVE® <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 +' 1y C O L O R A D O <br /> Prone:(303)866-3567 NOV L U Z018 RECVLAMATION <br /> FAX:(303)832-8106 MINING <br /> onnslory OF R>=cnor� SAFETY <br /> MINING AND SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE:D _ 'There is a File Number Already Assigned to this Operation <br /> Permit# M_- - (Please reference the file number currently assigned to this operation) <br /> Fs/1, <br /> _Ne w Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> _Conversion Application(Rule L 11) <br /> ?ermit# M - __ - (provide for Amendmzttts-and Conversions of existing permits) <br /> !rye application for a Construction Materials Regular 112 Operation Reclamation Pennit 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 ofExl ibits 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 /> s; 1/2" X 11" or g, l i2"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 ov print clearly,:n the space provided, ALL information requested below. <br /> I. Apo i;zanth orator or c e_n tanv name(name to be used on ermit): APC SOUTHERN CONSTRUCTION CO. LLC <br /> 1.1 Type of organization(corporation,partr-ersi il),etc.): Limited Liability Company <br /> 2. O eeation nLrn r=3 r sr or sites Dame): _FR/\`�IC'SCC .-, ` PIT #2 - <br /> Permitted»cl eaff� ,irv�r existi it u): 339 permitted acres <br /> 3.1 Change in acreagc(+1 acres <br /> +.2 Tctai a-creage i.a Pcnr...it area 339 acres <br /> 4. Fees. <br /> 4.1, New Appli--a:ion $2,696.00 application fee <br /> 4.2 New Quarry Application $3,342.00 quarry application <br /> 4.4 t�i-raendmcnt F;e $2,229.00 amendment fee <br /> 4.5 Conversion­3 ?12 ope:a Lon(set by statute; $2,696.00 conversion fee <br /> Sail: aI Roa lbase Structural fill <br /> Primary commoe.-ic4s) ---. -- <br /> - - ---- n�� ------ na <br /> 5.1 Incidental cnrnntoditie(s) is Ut raWiery: - a_si"i c�i 2. / lbs/Tons/yr <br /> 3. na —_ ibsiTors/lr 4.ria / Ih:g!Tor 5. na i lbs/Tons/yr <br /> i Cc.ncrctafacphalt aggregate, roadbase, structural fill <br /> 5.2 Antizipated, e 2 use of primary cornm: ditie ,(s)to mm u:-_--- <br /> 5.3 Anticipated cn:.':?se Oi 11:1?ut ;;al comr'.z—a tte(s)to be aii:aY.•1: i�Jria -- — <br />