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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> D"rmrbent of Natural Resources <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 C O L O R A D DIVISION OF <br /> Phone:(303)866.3567 RECLAMATION <br /> FAX:(303)832.8106 MINING <br /> SAFETY <br /> REGULAR(I l2d)DESIGNATED MINING OPERATION <br /> RECLAMATION PERM IT <br /> APPLICATION FORM <br /> CHECK ONE; 17 New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> Permit No.M-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 'A" X I I" or 8 'h" X 14" size. To expedite processing, please provide the <br /> information in the format and order described in this form, <br /> GENERAL OPERATIO'.ti INFORMATION <br /> Type or print clearly,in the space provided,all information described below. <br /> 1. Applicant/operator or companv name(name to be used on permit): <br /> Colorado Legacy Land, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Limited Liability Company <br /> 1.2 I.R.S.Tax ID No.or Social Security Number: 82-3835526 <br /> 2. Operation name(pit,mine or site....), Schwa rtmalder Mine <br /> 3. Permitted acreage:(new or existing site) 76.22 permitted acres <br /> 3.1 Change in acreage(-) acres <br /> 3.2 Total acreage in Permit area acres <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />