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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 /> �lE �. <br /> Denver,Colorado 80203 f�► �� <br /> COLORADO <br /> Phone:(303)866-3567 i v s 1 o N o f <br /> RECLAMATION <br /> FAX:(303)832-8106 WE 02 �RF MINING <br /> � AN <br /> PUmac '�/r SAFETY <br /> CONSTRUCTION MATERIALS 7 <br /> REGULAR(112)OPERATION O <br /> RECLAMATION PERMIT APPLICATION FORM N <br /> ° O <br /> M <br /> a <br /> CHECK ONE: There is a File Number Already Assigned to this Operation N <br /> Permit# M 1- �-_ (Please reference the file number currently assigned to this operation) o O <br /> 0 <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) (� <br /> 0—Conversion Application(Rule 1.11) <br /> Permit# M -,QAQ - (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 applica <br /> form;(2)Exhibits A-S,Addendum 1,any sections of Exhibit 6.5(Geotechnical Stability Exhibit;and(3)the application fee. When <br /> submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the comph e <br /> application form,two(2)copies of Exhibits A-S,Addendum 1,appropriate sections of 6.5(Geotechnical Stability Exhibit,and a chect o <br /> the applicationder <br /> fee described under Section(4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be fol C rt I3 <br /> 8 1/2 X 11 or 8 1/2 X 14 size. To expedite processing,please provide the information in the format and order described in this fc <br /> C� fA N <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided,ALL information requested below. <br /> 1. Applicant/operator or company name(name to be used on permit): Jel+� + Z(J(JNbAA1GIQi%A)- <br /> 1.1 Type of organization(corporation,partnership,etc.): %-M U '�-t rAA%Lv`j PA•R M 6 4-1i) U -p <br /> 2. Operation name(pit,mine or site name): A 1 G-61I 1J j WT- <br /> 3. Permitted acreage(new or existing site): 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 $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: C�em <br /> 5.1 Incidental commoditie(s)to be mined: 1. - lbs/Tons/vr 2. / lbs/Tons/vr <br /> 3. / lbs/Tons/vr 4. / !�lbs/Tons/vr 5. / lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: KOA& TA55C tAA,-I-E�(i4L <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: A <br />