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„ 13()b TATE OF COLORADO <br /> DIVISION ������® <br /> Depa,` <br /> mac <br /> tD <br /> RADO <br /> JAN 2 8 201g MATION <br /> F' / NING <br /> �zgp AGO <br /> SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: ✓Q— There is a File Number Already Assigned to this Operation <br /> Permit# M2D 17 005 (Please reference the file number currently assigned to this operation) <br /> 0—New Application(Rule 1.4.5) a Amendment Application(Rule 1.10) <br /> FL—Conversion Application(Rule 1.11) <br /> Permit# M 2017 G05 (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 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 requested below. <br /> 1. Apolicant/operator or company name(name to be used on permit): Fremont Paving and Redi Mix, Inc. <br /> 1.1 Type of organization(corporation,partnership,etc.): Corporation <br /> 2. Operation name fait,mine or site name): Goodrich Pit <br /> 3. Permitted acreage(new or existing site): 30 permitted acres <br /> 3.1 Change in acreage(+) 50 acres <br /> 3.2 Total acreage in Permit area 80 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: Gravel Aggregate <br /> 5.1 Incidental commoditie(s)to be mined: 1. - Ibs/Tons/vr 2 / Ibs/Tons/vr <br /> 3. / lbs/Tons/vr 4. / Ibs/Tons/yr 5. / Ibs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: Road Construction and utility infrastructure <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: Not Applicable <br />