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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 <br /> Denver,Colorado 80203 C O L O R A D O <br /> DIVISION OF <br /> Phone:(303)866.3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> SAFETY <br /> CONSTRUCTION MATERIALS <br /> SPECIAL(111)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> M 2� ICI- 021 <br /> The application for a Construction Materials Special I I I Operation Reclamation Permit contains four major parts:(1)the application form; <br /> (2)Exhibits A-L,Addendum 1,and any sections of Exhibit 6.5(Geotechnical Stability Exhibit),as required by the Office,and outlined in <br /> Rules 6.1,6.2,6.3,6.5,and 1.6.2(1)(b); (3)the application fee;(4)the Performance Warranty and if required a Financial Warranty.When <br /> you submit your application,be sure to include one(1)completed,signed and notarized ORIGINAL and one(1)copy of the completed <br /> application form,two(2)copies of Exhibits A-L,Addendum 1,appropriate sections of Exhibit 6.5(Geotechnical Stability Exhibit),as <br /> required,a check for the application fee described under(4)below,and the fully executed Performance Warranty and Financial Warranty,if <br /> required. Exhibits should NOT be bound or in 3-ring binders;maps should be folded to 8 2" X I I"or 8 2"X 14" size. To expedite <br /> processing,please provide the infomlation in the format and order described in this form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided,all information described below <br /> 1. Applicant/operator or company name(name to be used on the permit): <br /> Fremont Paving and Redi Mix, Inc. <br /> 1.1 Type of organization(corporation,partnership,etc.): Corporation <br /> 2. Operation name(pit,mine or site name): Buss Barrow Pit <br /> 3. Permitted acreaee: 7 Permitted Acres <br /> 4. New Application: S898.00 Application Fee <br /> 5. Primary commoditie(s)to be mined: Barrow Material <br /> 6. Name of owner to the surface of affected land: Darren and Donna Buss <br /> 7. Name of owner to the subsurface rights of affected land: Darren and Donna Buss <br /> 8. Type of minine operation: M Surface a Underground 1:3 In-situ <br /> 9. Location information: The center of the area where the majority of mining will occur: <br /> CO Fremont <br /> PRINCIPAL MERIDIAN(check one): J.J 6th(Colorado) ].!J IOth(New Mexico) n Ute <br /> SECTION(write number): S 13 <br /> TOWNSHIP(write number and check direction): T 48 North South <br /> RANGE(write number and check direction): R 10 ✓ East West <br /> QUARTER SECTION(check one): Virectio7frorn <br /> E NW SE SW <br /> QUARTER/QUARTER SECTION(check one): NW SE SW <br /> _-L-1­_ ]a <br /> GENERAL DESCRIPTION:(the number of miles an the nearest town and the approximate elevation): <br /> Three miles east of Howard Colorado south of Highway 50_ <br /> Office of Office of <br /> Mined Land Reclamation Denver - Grand Junction - Durango Active and Inactive Mines <br />