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_- STATE. OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY MECEIVED <br /> Department of Natural Resources g <br /> 1313 Sherman St.,Room 215 FED <br /> Denver,Colorado 80203 C O L O R A D O <br /> Phone:(303)866-3567AM02 DIVISION o F <br /> AMAT <br /> FAX:(303)832-8106 "' C(�-n�1 REM N I NGION <br /> w.�aw17 —&— <br /> JPUmac SAFETY <br /> 4� C-) <br /> CONSTRUCTION MATERIALS 3 3 <br /> REGULAR(112)OPERATION ° 7. <br /> — M ca <br /> RECLAMATION PERMIT APPLICATION FORM a Oo <br /> d <br /> c, , <br /> CHECK ONE: There is a File Number Already Assigned to this Operation m N <br /> Permit# M - -�-�/ (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> � <br /> Permit# M - -15 -12 1io (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 o' D <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 C t 3 <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 form. H <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided,ALL information <br /> j Cl. <br /> requested <br /> �I/U/!below.y <br /> 1. Applicant/operator or company name(name to be used on permit): 01/�Ilon an i[ l hl�i <br /> 1.1 Type of organization(corporation,partnership,etc.): /� <br /> 2. Operation name(pit,mine or site name): Elh�t CoutM _21f- <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) ,�,,,,II'' $2,696.00 conversion fee <br /> Land .5. Primary commoditie(s)to be mined: r v� L S i l ar k., <br /> 5.1 Incidental commoditie(s)to be mined: I. ��J,(WC,Ibs opg/vr 2. / Ibs/Tons/yr <br /> 3. / Ibs/Tons/vr 4. / lbs/Tons/yr 5. / lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined:_SUr-bx Qra ye4 . be inQ m&roials <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br />