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STATE OF COLOFADO <br /> DIVISION OF RECLAMATION,MINING ANn csctry <br /> Department of N. <br /> 1313 Sherman St. <br /> Denver,Coloradc COLORADO <br /> DIVISION OF <br /> APR u RECLAMATION <br /> Phone:(303)866 <br /> M2O224 <br /> FAX:(303)832-81 MINING <br /> )IVISION OF REC )NATION SAFETY <br /> MINING AND SAFETY <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,signed and notarized ORIGINAL and one(1)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 NOT 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 be used on the permit): <br /> 1.1 Type of organization(corporation,partnership,etc.): APC Southern Construction Co LLC <br /> 2. Operation name(pit,mine or site name): <br /> 3. Permitted acreage: 9.5 Permitted Acres <br /> 4. New Application: $898.00 Application Fee <br /> 5. Primary commoditie(s)to be mined: Sand and gravel <br /> 6. Name of owner to the surface of affected land: Barb Anderson <br /> 7. Name of owner to the subsurface rights of affected land: Barb Anderson <br /> 8. Type of mining operation: I v t Surface a Underground II In-situ <br /> 9. Location information: The center of the area where the majority of mining will occur: <br /> COU. <br /> PRINCIPAL MERIDIAN(check one): `� 6th(Colorado) 1-1 10th(New Mexico) n Ute <br /> SECTION(write number): S 33 <br /> TOWNSHIP(write number and check direction): T 41 North • South <br /> RANGE(write number and check direction): R 10 ✓ East 111 <br /> E-NE <br /> West — <br /> QUARTER SECTIO`(check one): NW 12 SE SW <br /> QUARTER/QUARTER SECTION(check one): NE NW is SE SW <br /> GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): <br /> I ess than one mile north of Hooper, CO at an elevation of 7548' <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />