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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources RECEIVE® <br /> 1313 Sherman St.,Room 215 /� �tt i <br /> Denver;Cdl'drdtfe-8Q203 C I L O R A D O <br /> � -� p I V I S. <br /> 1 0 N O F <br /> P�iig:(3�b) 7,�6'7►. S?��j 0 1) 018 (� �� l � � L' R)CLAMATION <br /> 3)832-&1UA�j•% `^'��11J MINING <br /> � - LiNCULi+I COUNTY SAFETY <br /> �+ /� = �•!.CRK&RECORDED <br /> L L� CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> cOl OaAp���.•��� 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 110) <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 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 V 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 /> I. Applicant/operator or company name(name to be used on permit): 04 *A i GCn1A)-S <br /> 1.1 Type of organization(corporation,partnership,etc).`r A1-'aA u U. rAAM _`{ .a-e—� <br /> 2. Operation name(pit,mine or site name): 4A[GC=kI'AJ3 <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: nA;,.i_ e_ <br /> 5.1 Incidental commoditie(s)to be mined: 1. - Ibs/Tons/yr 2. / lbs/Tons/yr <br /> 3. / Ibs/Tons/vr 4. / Ibs/Tons/vl 5. / Ibs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: ROOAh <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br />