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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 RECEIVED C O L O R A D O <br /> Denver,Colorado 80203 <br /> DIVISION O F <br /> Phone:(303)866-356702 RECLAMATION <br /> FAX:(303)832-8106 / APR 16 2019 MINING <br /> JPUmac I SA ETY <br /> DN1"OF ncLAMATION <br /> CONSTRUCTION MATERIALSMWW'MD SAFM <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 - 19 - 0 J- q (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 /> Permit# M -�- -UA I (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 acheck 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� requesteed below..,� <br /> I. Applicant/operator or company name(name to be used on permit): � insy Ian Ccns f u c4i un I o C <br /> 1.1 Type of organization(corporation,partnership,etc.): ,Q YJ')ro n <br /> 2. Operation name(pit,mine or site name): ` T CUU1IIA pl� a <br /> 3. Permitted acreage(new or existing site): 1 permitted acres <br /> 3.1 Change in acreage(+) /ACI •,1 acres <br /> 3.2 Total acreage in Permit area t4(jQ 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: Y' iLIL1_ Srl—ro <br /> 5.1 Incidental commoditie(s)to be mined: 1. h l- - lbs/Tons/yr 2. / lbs/Tons/yr <br /> 3. / lbs/Tons/vr 4. / lbs/Tona yr 5. / !' lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: S arkice, oyowel , berg U I nU rye a wf(AS <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: i'1 <br />