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COLORADO <br /> A 01 <br /> Division of Reclamation, '- <br /> Mining and Safety DMC/thm o <br /> y V <br /> Department of Natural Resources <br /> 1313 Sherman Street, Room 215 <br /> Denver,CO 80203 <br /> RECEIVED <br /> LIMITED IMPACT OPERATION(110(I)) <br /> RECLAMATION PERMIT JUL 3 0 2020 <br /> APPLICATION FORM <br /> DM310N OF RECLAMATION o 0 <br /> MINING&SAFETY ;2 ID <br /> �0 30 <br /> CHECK ONE: New Application F] Conversion Application(Rule 1.1 l) <br /> " Permit#M-2019 .007 (provide for conversions of existing permits) <br /> The application for a Limited Impact I I0(1) Mining Operation Reclamation Permit contains three major parts: (1)the application form; <br /> (2) Exhibits A-J, any required sections of Exhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules <br /> 6.l, 6.2, 6.3, and 6.5; and (3) the application fee. When you submit your application, be sure to include one (1) signed and notarized <br /> original and one(1)copy of the application form,two(2)copies of Exhibits A-J,and 6.5 (Geotechnical Stability Exhibit),as required,and <br /> a check for the application fee described under(4)below. Exhibits should not be bound or in a 3-ring binder;maps should be folded to 8 <br /> 1/2"X I I" or 8 1/2"X 14"size. To expedite 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 /> l. Applicant/operator or company name(name to be used on the permit): Asteroid Explorations LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): LLC Corp <br /> 2. Operation name(pit,mine or site name): KiChelmann One <br /> 3. Permitted acreaEe(must be 5 acres or less): 3 permitted acres <br /> 4. Fees: <br /> 24.27 <br /> Ne lication $288.00 application fee <br /> Amendment Applicat_ io $661.00 amendment fee <br /> 4.3 Conversion Fee(from 110(2)to I10(1),(Rule 1.11.2(2)) $288.00 conversion fee <br /> 5. Primary commodities)to be mined: Gold <br /> 6. Name of owner to the surface of affected land: Sally Kichelmann <br /> 7. Name of owner to the subsurface riEhts of affected land: Sally Kiechelmann <br /> 8. Type of minim operation: F] Surface R Underground R' Placer <br /> 1 <br />