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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 COL O R A D O <br /> ntvts1orr of <br /> Phone:(303)866-3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> M2020-025 SAFETY <br /> DMC/thm <br /> APPLICATION FORM ; �+� <br /> CHECK ONE: D New Application(Rule 1.4) FI Conversion Application(Rule 1.11) 1 LION <br /> _ �N1s10N®� <br /> Permit#M-2020 025 <br /> (provide for conversions of existing permits) MONO&SAFE" <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) sigmd an <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 I1"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 /> 1. Applicant/operator or company name(name to be used on the permit): Gregg Morrill <br /> 1.1 Type of organization(corporation,partnership,etc.): Individual <br /> 2. Operation name(pit,mine or site name): Bancroft Placer Mine <br /> 3. Permitted acreage(new or existing site): 9.4 permitted acres <br /> 4. Fees: <br /> 4.1 New Applitation $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 commoditie(s)to be mined: gold <br /> 6. Name of owner to the surface of affected land: Weimer Ranches, LLLP <br /> 7. Name of owner to the subsurface rights of affected land: Weimer Ranches, LLLP; UMETCO Mineral Corp <br /> 8. Type of mining operation: Z Surface Underground In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand{unction • Durango Active and Inactive Mines <br />