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'Z31TATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Re <br /> R A 1)0 F <br /> 1313 Sherman St-Room 215 C KADO <br /> Denver,Colorado 80203 M 1 976-007U,,', CNN! <br /> DIVISION OF <br /> Phone,(303)ON-M7 I <br /> FAX,(303)832-8106 /comphed! RECLAMATION <br /> G <br /> MINING <br /> SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION' <br /> RECLAMATION PERMIT APPLICATION FORM AU O 0 2 2021 <br /> OMSION OF RECLAMA <br /> CHECK ONE: There is a File Number Already Assigned to this Operation MIMNG&SA <br /> Pcnnil# N1 (Please reference the rile iiiiiiiberctirrci)tN.issi),,.ned to this operation) <br /> New Application(Rule 1.4.5) 0—Amendment Application(Rule 1.10) <br /> Conversion Application(Rule I.11) <br /> Permit# \ <br /> —�4 1976 0.07 UG (provide for Arrittulments and Coniersions,of existing permits) <br /> rhc application for a Construction Materials Regular 112 Operation Reclamation Per in contain.,,three inikiot pans:(1)the applicatiot <br /> fortri,(2)Exhibits A-S,Addendum 1,any sections of Exhibit 6,5 t Gcowchnica I Stability Exhibit:and(3)the application fee. Whellyok, <br /> subinit your application, be sure to include one 11) conitilcic signed and nowri/yd ORIGINAL and one t 1)copy of the completed <br /> application form.two(2)copies of Exhibits A-S.Addendum 1.appropriate sections of6.5(Geoicchnical StabiIny Exhibit,and olio",for <br /> the application fee described under Section(4)below. Exhibits should NOT be bound or in a 3-ring binder:maps should be folded to <br /> A l,'2" X I I"or?i 1,12"X 14"size. To expedite processing.please provide dw inforniation in the forinatand order described in this form. <br /> GENERAL OPERATION INFORMA HON <br /> Type or print clearly,in the space provided,ALL information requestetl below. <br /> I Aoi)licantionti!atororyomoanyoanw(name totwuwdon permit): Acme Brick Company <br /> 1.1 Typeoforganiz2tion(corporation partncrsbip,etc,): Corporation <br /> 2, 0eraGoa name(nit,mine or site name): Golden Mine <br /> permitted acres <br /> Permifted acreage.(new or exaltine site), 9,0 <br /> 3.1 Change in acreage(+) 76.51 acres <br /> 3.2 Total acreage in Permit area 86.51 acres <br /> 4. Fees: <br /> 4,! New Application S2.6960) application lee <br /> 4-2 New Quarry Application S11424)(1 quarry application <br /> 4A Amendment Fee S2.2290) amendment tee <br /> 4.5 Conversion to It 2 operation(set by statute) $2,6909) conversion fee <br /> 5. Primry commodide(s)to be mined: clay <br /> 5.1 lncidetitalcotiunoditio(s)tobeinined: I. NA lbsTl'onv T 2 lbs-'Tonsv <br /> 3. f lbs"Tons/Iff 4, -lbs"Ton 5, lbs.Tons <br /> 5,2 Anticipated end use of prftnary colmnDditic(s)to be tnined- brick <br /> , NA <br /> 5.3 Anticipated end use of incidental comitioditic(s)to be inured: <br />