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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING ANn "'— <br /> Department of Natnr-I 048 <br /> 1313 Sherman'. M2021 C O L O RA D O <br /> Denver, 03)8 c —ER REC DIVri AMATION <br /> Phone:(303)86t �•dm �� <br /> FAX:(303)832-8 <br /> ENT �NC�UDED• MINING <br /> *ND PAYM �j SA FETY <br /> CONSTRUCTION MATERIALS RID <br /> SPECIAL(111)OPERATION JUL 16 2021 <br /> RECLAMATION PERMIT APPLICATION FORM DIVISION OF <br /> MINING&SAF�TION <br /> The application for a Construction Materials Special I I I Operation Reclamation Permit contains four major parts:(1)the application form; <br /> (2)Exhibits A-L,Addendum 1,and any sections of Exhibit 6.5(Geotechnical Stability Exhibit),as required by the Office,and outlined in <br /> Rules 6.1,6.2,6.3,6.5,and 1.6.2(1)(b); (3)the application fee;(4)the Performance Warranty and if required a Financial Warranty.When <br /> you submit your application,be sure to include one(1)completed,signed and notarized ORIGINAL and one(1)copy of the completed <br /> application form,two(2)copies of Exhibits A-L,Addendum 1,appropriate sections of Exhibit 6.5(Geotechnical Stability Exhibit),as <br /> required,a check for the application fee described under(4)below,and the fully executed Performance Warranty and Financial Warranty,if <br /> required. Exhibits should NOT be bound or in 3-ring binders;maps should be folded to 8 2" X I I"or 8 2" X 14" size. To expedite <br /> 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 described below <br /> 1. Applicant/operator or company name(name to be used on the permit): <br /> ZA K Di It-r i,uc. <br /> 1.1 Type of organization(corporation,partnership,etc.): <br /> 2. Operation name(pit,mine or site name): (ld(2-N`v P r T <br /> 3. Permitted acreaee: jt`� 2 .o Permitted Acres <br /> 4. New Application: `�t;S $898.00 Application Fee <br /> 5. Primary commoditie(s)to be mined: GV(LQ.ow ?Ir Dr2>` rrM gANa•N�ruT <br /> 6. Name of owner to the surface of affected land: -SAr^ES C12A"e2 , i-tSA c:(LA"*1t'Z <br /> 7. Name of owner to the subsurface rights of affected land: 3a^"is C:QA-J-c re r L,5 A c �AJNL lZ <br /> 8. Type of minine operation: Surface a Underground n In-situ <br /> 9. Location information: The center of the area where the majority of mining will occur: <br /> co � �6th(Co�lorado) <br /> PRINCIPAL MERIDIAN(check one): U j l Oth(New Mexico) Ute <br /> SECTION(write number): S Z_� <br /> TOWNSHIP(write number and check direction): T _ North South <br /> RANGE(write number and check direction): R 4- East West <br /> QUARTER SECTION(check one): �P-E NW SE SW <br /> QUARTER/QUARTER SECTION(check one): E NW SE SW <br /> GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand junction • Durango Active and Inactive Mines <br />