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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 /> Phone:(303)866-3567 U t V I S 1 0 N o f <br /> CN01RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> —&— <br /> SAFETY <br /> BFB/mac <br /> CONSTRUCTION MATERIALS RECE'YED <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM n <br /> �+ <br /> F �52 o <br /> a e d'4 3 <br /> � met l.mciaiaATiON <br /> CHECK ONE:w There is a File Number Already Assigned to this Operation 5' <br /> Permit# M1 as o"0 (Please reference the file number currently assigned to this operation) G <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) ? N <br /> O <br /> 0—Conversion Application(Rule 1.11) <br /> Permit# M ?983 _050 _ (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 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 11"or 8 1/2"X 14"size. To expedite processing,please provide the information in the format and order described in this form. <br /> o In <br /> m <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided,ALL information requested below. <br /> 1. Applicant/overator or company name(name to be used on permit): PHILLIPS COUNTY <br /> 1.1 Type of organization(corporation,partnership,etc.): GOVERNMENT <br /> 2. Operation name(pit,mine or site name): J E N S E N P I T <br /> 3. Permitted acreage(new or existing site): 9•9 permitted acres <br /> 3.1 Change in acreage(+) 8.35 acres <br /> 3.2 Total acreage in Permit area 18.25 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 commodities)to be mined: SAND GRAVEL <br /> 5.1 Incidental commoditie(s)to be mined: 1. CLAY 5000 Tlbs/Tons/yr 2. / lbs/Tons/yr <br /> 3. / lbs/Tons/vr 4. / lbs/Tons/vr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: ROAD GRAVEL AND BASE <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: ROAD BASE <br />