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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MIN►Mr.A►Jn CAFFTY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 C O L O R A D F <br /> M20�20-013D I V i 5 1 ON O F <br /> Phone:(303)866-3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> DMC/thm SAFETY <br /> LLVIIYED LWAI.,t VrEKAI WIN t11VtL1/ <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> RECEIVED <br /> CHECK ONE: l New Application(Rule 1.4) EL Conversion Application(Rule 1.I 1) ,�EB 0 7 420 <br /> DMSION OFCLAM,ATIO�N <br /> Perrot#M- - (provide for conversions of existing permits) MINING AND SAFETY <br /> The application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br /> form; (2) Exhibits A-J, any required sections of Exhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in <br /> Rules 6.1,6.2. 6.3,6.4.19 and 6.5; and(3) the application fee. When you submit your application,be sure to include one(1)steed and <br /> notarized original and one(1)copy of the application form,two(2)copies of Exhibits A-J,appropriate sections of 6.4.19 Exhibit S and 6.5 <br /> (Geotechnical Stability Exhibit), as required,and a check for the application fee described under(4)below.Exhibits should not be bound <br /> or in a 3-ring binder;maps should be folded to 8 1/2" X I I"or 8 1/2"X 14" size. To expedite processing,please provide the information <br /> 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 /> I. Applicant/operator or companv name(name to be used on the_permit): C RG Mining LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Operation name(pit,mine or site name): Raymond Mine <br /> 3. Permitted acreage(new or existing site): 8.60 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $1,006.00 application fee <br /> 4.2 Amendment Application(from 1.10(2)) <br /> 4.3 Conversion Fee(from I IOd to 110(2),(Rule 1.11.2(2)) $1.725.00 conversion fee <br /> 5. Primary commodities)to be mined: Gold, Silver <br /> 6. Name of owner to the surface of affected land: Fossil Creek Mines LLC <br /> 7. Name of owner to the subsurface rights of affected land: Fossil Creek Mines LLC <br /> 8. Type of minim operation: El Surface 21 Underground 0 In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand)unction • Durango Active and Inactive Mines <br />