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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources <br /> s aNd N1NIW <br /> 313 Sherman St.,Room 215 9'6�O NOISI/110 <br /> Inver,Colorado 80203 C O L O R A D O <br /> .,hone:(303)866-3567M20 D l V 15 l O N o e <br /> FAX:(303)832-8106 b Z Ow REM MINING <br /> � ee�� PSH/mac v�n1333N SA E�TY <br /> 6el�v` CONSTRUCTION MATERIALS <br /> LIMITED IMPACT 110 OPERATION ftece <br /> ( ) IVLep <br /> RECLAMATION PERMIT APPLICATION FORM MAY +C 4 2019 <br /> CHECK ONE: There is a File Number Already Assigned to this Operation _,AIJ ,�CL4 77ON <br /> Permit# M - - (Please reference the file number currently assigned to this operation) <br /> ✓ New Application(Rule 1.4.5) J71—Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> Permit# M - - - (provide for Amendments and Conversions of existing pen-nits) <br /> The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br /> application form;(2)Exhibits A-J,Exhibit L,Addendum 1,any sections of Exhibit 6.5 and Geotechnical Stability Exhibit,as required by <br /> the Office,and outlined in Rules 6.1,6.2,6.3,6.5,and 1.6.2(1)(b);and(3)the application fee. When you submit your application,be sure <br /> to include one (1)complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of <br /> Exhibits A-J, Exhibit L,Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br /> iplication fee described under(4)below. Exhibits should NOT be bound or in a 3-ring binder;maps should be folded to 8 1/2"X I I"or 8 <br /> /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 described below. <br /> 1. Applicant/operator or company name(name to be used on permit): Colorado Sand Company LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Colorado Limited Liability Corporation <br /> 2. Operation name(pit,mine or site name): Keenesburg Project <br /> 3. Permitted acreage(new or existing site): 9.9 pennitted acres <br /> 3.1 Change in acreage(+) N/A acres <br /> 3.2 Total Acreage in Permit Area 9.9 acres <br /> 4. Fees: <br /> 4.1 New Application: $1258.00 application fee <br /> Amendment Fee(C.R.S. 34-32.5-125(I1)): $827.00 application fee <br /> 5. Primary commoditie(s)to be mined: Sand <br /> 5.1 Incidental commoditie(s)to be mined: 1. N/A / lbs/Tons/yr 2. / lbs/Tons/yr 3. / lbs/Tons/vr <br /> 4. / lbs/Tons/yr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: Industrial Uses <br /> Anticipated end use of incidental commoditie(s)to be mined: N/A <br />