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COUNTY �.r_ <br /> �°r STATE OF COLORADO <br /> _«i ung IAvso� (!C�c''�on �oul�i7 p' r,;. 5te ?tip. fY <br /> W�� fG�.�C� <br /> ;i` 1 7 'fU( 3ck-^ COLO ROAD <br /> DIVISION OF <br /> RECLAMATION <br /> ~ MINING <br /> p l'- SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: ✓�_ There is a File Number Already Assigned to this Operation <br /> permit# M - 1988- 108- (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) �Amendment Application(Rule 1.10) <br /> D—Conversion Application(Rule 1.11) <br /> Permit# M _1988 -108 _ (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Regular 1]2 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 ofExhibits 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. Aimlicant/operator or company name(name to be used on permit): Arcosa LWB, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Corporation <br /> 2. Operation name(nit,mine or site name): Arcosa Lightweight- Boulder <br /> 3. Permitted acreage(new or eaistine site): 108.04 permitted acres <br /> 3.1 Change in acreage(+) 31.0 acres <br /> 3.2 Total acreage in Permit area 139.04 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 $2229.00 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: Shale <br /> 5.1 Incidental commoditie(s)to be mined: 1. N/A - ]bs/Tons/vr 2. / lbs/Tons/vr <br /> 3. / lbs/Tons/yr 4. / lbs/Tons/vr 5. / lbs/Tons/yr <br /> Asphalt surface treatment,lightweight concrete,concrete masonry,geotechnical fill,etc. <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: N/A <br />