2021-07-29_REVISION - M1977300 (13)

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-2- 4. Fees: 4.1 New 112d(1)Application(affecting less than 50 acres and extracting less than I million tons per year) $4,025.00 application fee 4.2 New 112d(2)Application(larger than above but affecting less than 100 acres and extract less than 5 million tons per year $6,900.00 application fee 4.3 New I I2d(3)Application(any other operation) $9,200.00 application fee 4.4 Existing 112d(1)Amendment Fee $2,300.00 amendment fee 4.5 Existing 1 12d(2)Amendment Fee $4,025.00 amendment fee 4.6 Existing 112d(3)Amendment Fee $7,475.00 amendment fee 4.7 New 112d(I)Amendment Fee $2,875.00 amendment fee 4.8 New 112d(2)Amendment Fee $4,600.00 amendment fee 4.9 New I I2d(3)Amendment Fee $8,050.00 amendment fee 4.10 Conversion Fee see above application fees 5. Primary commodities)to be mined: NA - Closure 6. Name of owner of surface of affected land: Colorado Legacy Land, LLC 7. Name of owner of subsurface rights of affected land: Colorado Legacy Land, LLC If 2 or more owners,refer to Exhibit O. 8. Type of mining operation: F-1 -Surface Underground 9. Location Information: the center of the area where the majority of mining will occur lies in: COUNTY: Jefferson PRINCIPAL MERIDIAN(check one): 6th(ColoradoDOth(New Mexico) 0 Ute SECTION(write number): S 25 TOWNSHIP(write number and check direction): T 2 EL North South RANGE(write number and check direction): R 71 aEast West QUARTER SECTION(check one): NW SE SW QUARTER/QUARTER SECTION(check one): NE NWF�J SE BW GENERAL DESCRIPTION (miles and direction from nearest town and approximate elevation): Located approximately 6,600 ft amsl and 6 miles northwest of Golden, Colorado. 10. Primary Mine Entrance Location (report in either Latitude/Longitude OR UTM): Latitude/Longitude: Example: (N) 390 44' 12.98" (W) 104° 59' 3.87" Latitude(N): deg min sec (2 decimal places) Longitude(W): deg min sec (2 decimal places)