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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources RECEIVED <br /> 1313 Sherman St. <br /> Denver,Colorado, D IV C O L O R A D O <br /> Phone:(303)866- 04 JUL 2 2 2019 I ON OF <br /> P L SAMATION <br /> FAX:(303)832-811 1 9 MINING <br /> IA-20 <br /> SJM/thm �ux of RECLAMATION SAFETY <br /> M AND SAFETY <br /> ff CONSTRUCTION MATERIALS <br /> LIMITED IMPACT(110)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: There is a File Number Already Assigned to this Operation <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 /> Permit# M - - - (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Limited Impact(110) Operation Reclamation Permit contains three major parts: (1)the <br /> application form;(2)Exhibits AA,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 /> application 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 11"or 8 <br /> 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 described below. <br /> 1. Applicant/operator or company name(name to be used on permit): Cornerstone Materials, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Limited Liability Corporation <br /> 2. Operation name(pit,mine or site name): Farm Road Source <br /> 3. Permitted acreage(new or existing site): 9.98 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: $1258.00 application fee <br /> Amendment Fee(C.R.S.34-32.5-125(II)): $827.00 application fee <br /> 5. Primary commoditie(s)to be mined: Gravel <br /> 5.1 Incidental commoditie(s)to be mined: 1. / Ibs/Tons/vr 2. / Ibs/Tons/vr 3. / Ibs/Tons/yr <br /> 4. / lbs/Tons/yr 5. / Ibs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: road construction aggregate <br /> Anticipated end use of incidental commoditie(s)to be mined: <br />