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STATE OF COLORADO <br /> DIVISION OF RECLAMATION, MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313ShenmanSt„Rcom215 <br /> Denver,Coloodo80203 D IT/1051100 <br /> Or1OR ND0 <br /> Phone: (303)86&3567 RECLAMATION <br /> FAX: (303)832.8106 MINING <br /> CONSTRUCTION MATERIALS <br /> SPECIAL(111) OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> The application for a Construction Materials Special 111 Operation Reclamation Permit contains four major parts:(1)the application form; <br /> (2)Exhibits A-L, Addendum 1,and any sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required by the Office, and outlined in <br /> Rules 6.1, 6.2,6.3, 6.5,and 1.6.2( 1 )(b); (3)the application fee; (4) the Performance Warranty and if required a Financial Warranty.When <br /> you submit your application,be sure to include one (1) completed. siened and notarized O i NA . and one (I ) copy of the completed <br /> application form, two (2) copies of Exhibits A-L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as <br /> required,a check for the application fee described under(4)below, and the fully executed Performance Warranty and Financial Warranty,if <br /> required. Exhibits should NQT be bound or in 3-ring binders; maps should be folded to 8 2” X 11" or 8 2" X 14" size. To expedite <br /> 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 he used on the.permit); <br /> Fremont Paving and Redi-Mix,Inc. <br /> 1.1 Type of organization(corporation,partnership,etc.): Corporation <br /> 2. Operation name(pitmine or site name): Horse Creek Pit <br /> 1. Permitted Acres: 2. 30.0 Permitted Acres <br /> 3. New Application: $898.00 Application Fee <br /> 4. Primary commoditie(sl to be mined; sand and gravel <br /> 5. Name of owner to the surface of affected land; Colorado State Land Board <br /> 6. Name of owner to the subsurface riehts of affected land Colorado State Land Board <br /> S. Time of mining operation: E✓ Surface E Underground a In-situ <br /> 9. J.ocation information; The center of the area where the majority of mining will occur: <br /> PRINCIPAL MERIDIAN(check one): ✓ Dolorado) 1[11ew Mexico) to <br /> SECTION (write number): S 12 <br /> TOWNSHIP (write number and check direction) : T 15 North V South <br /> RANGE(write number and check direction): R 51 . East ✓ West <br /> QUARTER SECTION(check one): 0 It NW ✓ SE SW <br /> QUARTER/QUARTER SECTION(check one): NE I1 NW V SE SW <br /> GENERAL DESCRIPTION': (the number of miles and direction from the nearest town and the approximate elevation): <br /> 35 miles south of Limon. CO at an elevation of 5060 feet. <br /> Office of Office of <br /> Mined Land Reclamation Denver•Grand junction• Durango Active and Inactive Mines <br />