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STATE OF COLORADO <br /> DIVISION OF RECLAMATIMI �•� • <br /> Department c <br /> � ► 3 <br /> 1313 Sherma DECEIVED � � <br /> Denver,Color DC O L 0 <br /> Phone:(303)1 CN01RE 0 W <br /> FAX:(303)83: pEI0 062019 M p -4 <br /> JPUjle _ 00 <br /> DIVISION OF RECLAMATION S @ a C <br /> MINING&SAFETY o O <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 - 1 1 FWD-_ (Please reference the file number currently assigned to this operation) 0 <br /> New Application(Rule].4.5) 0—Amendment Application(Rule 1.10) o <br /> Conversion Application(Rule LI 1) � = Z <br /> � 0 O <br /> Permit# M (provide for Amendments and Conversions of existing permits) N �a <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 ofExhibit 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 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 1 1"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. Applicant/operator or company name(name to be used on permit): L r-,C-0`n Co unLj <br /> 1.1 Type of organization(corporation,partnership,etc.): (-e!?SI {u ('-�-)t e r n M c-- r-i t <br /> 2. Operation name(pit,mine or site name): G,m e r O t�2 O rcty e� ?I"C <br /> 3. Permitted acreage(new or existing site): 9.9 permitted acres <br /> 3.1 Change in acreage(+) k 0 acres <br /> 3.2 Total acreage in Permit area �� ,q 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: q� — <br /> 5.1 Incidental commoditie(s)to be mined: 1. - 0 lbs/Tons/y 2. Q / lbs/Tons/yr <br /> 3. D / lbs/Tons/yr 4. / lbs/Tons/yr 5. © / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: r-o u ct� cnai r)te.netnc e <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: N i A <br />