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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />STATE OF COLORADO <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: F There is a File Number Already Assigned to this Operation <br />COLORADO <br />D IVI S I ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Permit li M --Lo --10 -Q(Please reference the file number currently assigned to. this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1).4omplete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps should be folded to <br />8 1/2" X 11 " 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 requested below. <br />1. Applicant/operator or company name (name to be used on permit): ^F <br />1.1 Type of organization (corporation, partnership, etc.): �e�D <br />2. Operation name it mine or site name): L n gra <br />T`. <br />3. Permitted acresee (new or existing „site): <br />permitted acres <br />3.1 <br />Change in acreage (+) <br />acres <br />3.2 <br />Total acreage in Permit area <br />acres 4 <br />4. Fees: <br />4.1 <br />New Application <br />$2.696.00 application fee <br />4.2 <br />New Quarry Application <br />$3,342.00 quarry application <br />4.4 <br />Amendment Fee <br />$2,229.00 amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />$2,696.00 conversion fee <br />5. Primary commoditie(s) to be mined:�� <br />5.1 <br />Incident i commoditie(s) to be mined: 1.K4Ib To r <br />2. Nr Ibsl 000n)I r <br />3.J4n 1 lb nn r 4. t lbs/Tons/vr <br />5. ! lbs/Tons/yr <br />5.2 <br />Anticipated end use of primary commoditie(s) to be mined: <br />5.3 <br />Anticipated end use of incidental commoditie(s) to be mined: f(w eSS �b e <br />Lc., <br />