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STATE OF COLORADO <br /> DIVISIO RECEIVeD <br /> Departm< M1977-300 <br /> She ✓oompedl AM06 <br /> Den , <br /> Denver, 11 Minor Infractions <br /> �� C O L O R A D Octions 3 Violations DIV IS 10 N OF <br /> Phone: PAYMENT INCLUDED WITH APPLI ATI N�maGawa OMSION OF REC RECLAMATION <br /> FAX:(3a LAMATION MINING <br /> MINING&SAFETy <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.1M-1977 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 %i' X I V or 8 '/2" 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 /> 1. Applicant/operator or company name(name to be used on permit): <br /> Colorado Legacy Land <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): Schwartzwalder Mine <br /> 3. Permitted acreage:(new or existing site) 76.22 permitted acres <br /> 3.1 Change in acreage(+) 0 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 />