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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 tIRLEECLAMATION <br /> R A D F <br /> Phone:(303)866-3567 roN OF <br /> FAX:(303)832-8106 NING <br /> &— <br /> SAFETY <br /> REGULAR(112d)DESIGNATED MINING OPERATION <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CHECK ONE: New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> Permit No.M-1 977 _300 (provide for amendments and conversions of existing permits) <br /> The application for a Regular(112d)Designated Mining Operation Reclamation Permit contains three major parts: (1) the application form; <br /> (2)Exhibits A-T,Geotechnical Stability Exhibit,the Emergency Response Plan,and Addendum 1, as required by the Office,and outlined in Rules <br /> 6.1,6.2,6.3,6.4.19,6.5,8.0,and 1.6.2(1)(b);and,(3)the application fee. When you submit your application,be sure to include one(1)signed and <br /> notarized original and four(4)copies of the application form, five(5)copies of Exhibits A-T,Rule 6.5 Geotechnical Stability Exhibit,the <br /> Emergency Response Plan,Addendum 1,and a check for the appropriate application fee(described under Section(4) on Page 2). Exhibits should <br /> not be bound or in a 3-ring binders; maps should be folded to 8 ''/2" X 11" or 8 'h" X 14" size. To expedite processing,please provide the <br /> 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 /> I. Applicant/operator or company name(name to be used on permit): <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 1.2 I.R.S.Tax ID No.or Social Security Number: <br /> 2. Operation name(pit,mine or site name): Schwartzwaidef Mine <br /> 3. Permitted acreage:(new or existing site) 72.24 permitted acres <br /> 3.1 Change in acreage(+) 3.98 acres <br /> 3.2 Total acreage in Permit area 76.22acres <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />