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COL, ORA ? O R� +�, <br /> Division of Reclamation, <br /> Mining and Safety VFD <br /> Department of Natural Rcsouvices kL 7 4_ , A169 <br /> 1313 Sherman Street, Room 215 M�2018 06 b�/�yYRFC <br /> Denver, CO 80203 ERPJmaCgNpq <br /> LIMITED IMPACT OPERATION(110(1)) <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CHECK ONE: X New Application a Conversion Application(Rule 1.11) <br /> Permit#M- - (provide for conversions of existing permits) <br /> The application for a Limited Impact I I0(1) Mining Operation Reclamation Permit contains three major parts: (1)the application form; <br /> (2) Exhibits A-J, any required sections of Exhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules <br /> 6.1, 6.2, 6.3, and 6.5; and (3) the application fee. When you submit your application, be sure to include one (1) signed and notarized <br /> original and one(1)copy of the application form,two(2)copies of Exhibits A-J,and 6.5(Geotechnical Stability Exhibit),as required,and <br /> a check for the application fee described under(4)below. Exhibits should not be bound or in a 3-ring binder;maps should be folded to 8 <br /> 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 described below <br /> 1. Applicant/operator or company name(name to be used on the permit): 2nd Generation Mining, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Operation name(pit, mine or site name): JJ Collecting Project #1 <br /> 3. Permitted acreage(must be 5 acres or less): 2 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 4.2 Amendment Application $664.00 amendment fee <br /> 4.3 Conversion Fee(from 110(2)to I10(1),(Rule 1.11.2(2)) conversion fee <br /> 5. Primary commodities)to be mined: Mineral specimens (e.g., smoky quartz, amazonite, fluorite) <br /> 6. Name of owner to the surface of affected land: U.S. Forest Service <br /> 7. Name of owner to the subsurface rights of affected land: Jeff Schimel and Jim Reed <br /> 8. Type of mining operation: Surface F-1 Underground Placer <br /> 1313 Sherman Street, Room 215, Denver, CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us w <br /> John W. Hickenlooper, Governor I Mike King, Executive Director Virginia Brannon, Director <br />