2019-01-23_REVISION - M1995008 (3)

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l� f l Il I Il l Il llll 111.12) FEB o 3 999 r rarri.st:wr1UN FORM pp�� CHECK ONE: X New Application (Rule 1.4-5) Amendi ft�I�pr�v[xu t 1.10) Conversion Application (Rule 1.11) Permit No. M- (provide for amendments and conversions of existing permits) The application for a Regular Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A -S and Geotechnical Stability Exhibit; and, (3) the application fee. When you submit your application, be sure to include one (1) signed and notarized original and four (4) copies of the application form, five (5) copies of Exhibits A -R and any required sections of Exhibit S and the Geotechnical Stability Exhibit, and a check for the application fee described under Section (16) on Page 3. Exhibits should not be bound or in a 3 -ring binder; maps should be folded to 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 form. m -7 GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/operator or company name (name to be used on permit): Fremont Paying R_Redi-Mix, Inc. _ 1.1 Type of organization (corporation, partnership, etc Corporation 1.2 I.R.S. Tax ID No. or Social Security Number: 2. Operation name (pit, mine or site name): Florence P -t 3. Permitted acreage (new or existing site) 3.1 Change in acreage (+ or -) 3.2 Total acreage in permit area 4. Fees: 4.1 New Application 4.2 New Quarry Application 4.3 Milling Application (Non -DMO 4.4 Amendment Fee 4.5 Conversion to 112 operation 5. Primary commodities) to be mined: 14.4± permitted acres acres acres $1,875.00 application fee $2,325.00 quarry application $3.100.00 milling application $1,550.00 amendment fee (set by statute) $1,500.00 conversion fee 6. Name of owner of surface of affected land: sand and gravel Refer to Exhibit P 7. Name of owner of subsurface rights of affected land: Refer to Exhibit P If 2 or more owners, refer to Exhibit 0. B. Type of mining operation: X Surface , Underground _ In-situ 9. Location Information: the center of the area where the majority of mining will occur lies in: ' COUNTY. Fremont' r ergo n t PRINCIPAL MERIDIAN (check one): X 6th (Colorado) 10th (New Mexico) _ Ute SECTION (write number) : S 76 TOWNSHIP (write number and check direction): T ^19North X South RANGE (write number and check direction): R = _ East g West QUARTER SECTION (check one):NE _ _SW QUARTER/QUARTER SECTION (check one): _ NE NW SE SW A GENERL DESCRIPTION (miles and direction fromnearest town and approximate elevation): .ApproximareLy 0.25 m -le Zorth of FZnrPncP_ A22ro7cirriately 5,250 ft, elevation. ORIGINAL