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STATE CIF COLORADO <br /> DIVMON OF RECLAMATION,MINING AND SAFELY <br /> De w*wkt of Natural Rawirm <br /> 13 Sherman st,Room 213 <br /> n .Cololub 00203 DC O L O O N Of <br /> m 003)0663567 RECLAMATION <br /> FAX-003)8324106 MINING <br /> LIMITED IMPACT OPERATION(110(2)) SAFETY <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CIiEC QNE: —0 New Application(Rule 1.4) M Conversion Application(Rule I.11) <br /> Permit#M-1977 .410 (pmyide for conversions of existing permits) <br /> The application for a Limited impact Designated Mining Operation Reclamation Permit contains tlmee major parts: (1)the application <br /> form; (2)Exhibits A-J, any required sections of Exhibit S and Geotechnical Stability Exhibit,as required by the Office,and outlined in <br /> Rules 6.1.6.2.6.3.6.4.t 9 and 6.5:and(3)the application fee. When you submit your application.be sure to include one(1) <br /> nit riz�e original sand one(1)copy of the application form,two(2)copies of Exhibits A-J,appropriate sections of 6.4.19 Exhibit 5 and 6.5 <br /> (Geotodmical Stability Exhibit),as required,and a check for the application fee described under(4)below.Exhibits should not be bound <br /> or in a 3-ring binder;imps should be folded to R 1/2" X 1 i"or B 112"X 14"size. To expedite processing,please provide the motion <br /> 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 /> AmUcant/gwrator or woman#name fame to be uud_o_n the permit): Grand Island Resources, LLC (GIR) <br /> 1.1 Type of organization(corporation,partnership,etc.): Partnership <br /> 2. Oueraden nam(o16 mine oy s(e n:me): Cross Gold Mine <br /> 3. (new or ejMpt site): 9.99 pitied acres <br /> 4, ear. <br /> 4.1 New Application $1,006s00 application fee <br /> 4.2 Amendment Application(from 1.l0(2)) <br /> 4.3 Conversion Fee(from 1 IOd to 110(2),(Rule 1.11.2(2)) $1,725.00 conversion fee <br /> 3. �8 �� ;�tQ Gold and Silver <br /> 6. Name of ownr to the sudage of affa*il Iand: Grand I sland Resources, LLC <br /> 7. Name of owner to the sabsarfaee rhts of affected land: Grand Island Resources, LLC <br /> S. Type of minlnn 9g!Mation. Surface D Underground 1:1In-situ <br /> Office d Office of <br /> Mined land Reclamation Derive - Grand junction • Durarip Active and Inactive Mines <br />