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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,P <br /> Department CO Natural Resources <br /> 113 Shemin St,Room 215 M 1977-410 AM02 <br /> aver Cobrado 80203 C O L O R A D F <br /> Phase:CM31866-3567 Complied! 1 Violation D m v i s 1 O N o f <br /> FAX(303)$32-8106 8 Minor Infractions AME/mac/awa REMILINMIANTGON <br /> LMWED IMPACT OPERATION(110(2)) SAFETY <br /> RECLAMATION PERMIT <br /> APPLICATION FORM "wSLE IVE'D <br /> JAN 0 8 2021 <br /> CHECK ONE: �,New Application(Rule 1.4) Conversion Application(Rule 1.11) <br /> DIVISION OF RECLAMATION <br /> Permit it M-1977 .410 (provide for conversions of existing permits) MINING AND SAFETY <br /> The application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br /> form; (2) Exhibits A-1, any required sections of Exhibit S and Geotechnical Stability Exhibit, as required by the Once,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)si and <br /> tariz original and one(1)copy of the application form, two(2)copies of Exhibits A-1,appropriate sections of 6.4.19 Exhibit S and 6.5 <br /> (Geotexbnical Stability Exhibit),a,rcxluired,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 R 1/2" X l I" or 8 1/2"X 14" size. To expedite processing,please provide the information <br /> in time 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 /> ). Appllcan%operator or company name(name to be used on the permit): Grand Island Resources, LLC (GIR) <br /> 1.1 Type of organizarion(corporation, partnership,etc.): Partnership <br /> 2. Operatdon nam(ph,mine of site L►ameZ Cross Gold Mine <br /> 3. armhted acrea¢e(new or elMair site): 9.99 permitted acres <br /> 4. Lem <br /> 4.1 New Application �1,0[%00 application fee <br /> 4.2 Arocndmcnt Application(from I.10(2)) <br /> 4.3 Conversion Fee(from 1 IOd to 110(2),(Rule 1.11.2(2)) $1.725.00 conversion fee <br /> s. rm mwy tommaitic(s)to be wined; Gold and Silver <br /> 6. Now of owner to time surface of affected land: Grand Island Resources, LLC <br /> 7. Nam of owner to the st>tbsurfaee&hts of affected land: Grand Island Resources, LLC <br /> 8. Trpe of minina operation: Surface W1 Underground In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver - Grand Junction - Durango Active and Inactive Mines <br />