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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 rCOLORADO <br /> Phone-(303) 2-810 57 M-2020-065 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> �TNIUth / � a SAFE <br /> �7 TY <br /> CONSTRUCTION MATERIALS .,,,,� <br /> REGULAR(112)OPERATION <br /> t1 r� <br /> RECLAMATION PERMIT APPLICATION FORM .�, j �� �L J <br /> CHECK ONE:0— There is a File Number Already Assigned to this Operation <br /> Permit# M - - (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> 0— <br /> Li—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) complete 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 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 requested below. <br /> 1. Applicant/operator or company name(name to be used on permit): Colorado GatorS Inc <br /> 1.1 Type of organization(corporation,partnership,etc.): Corporation <br /> 2. Operation name(pit,mine or site name): MYStiC Soil <br /> 3. Permitted acreage(new or existing site): 319•8 permitted acres <br /> 3.1 Change in acreage(+) acres <br />