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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 �� <br /> Denver,Colorado 80203 C O L O R A D O <br /> E <br /> DIVISION OF <br /> Phone:(303)866-3567 RECLAMATION <br /> FAX:(303)832-8106 S EP 0 2 ZOZZ MINING <br /> SAFETY <br /> DIVISION SA FETYI-MtNERANS <br /> CONSTRUCTION MATT <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE:Q— There is a File Number Already Assigned to this Operation <br /> Permit# M - - (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) 13—Amendment Application(Rule 1.10) <br /> ✓ Conversion Application(Rule 1.11) <br /> Permit# M _ 19 - 81 075 (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts:(1)the app lication <br /> form;(2)Exhibits A-S,Addendum 1,any sections of Exhibit 6.5(Geotechnical Stability Exhibit;and(3)the application fee. When you <br /> submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br /> application form,two(2)copies of Exhibits A-S,Addendum 1,appropriate sections of 6.5(Geotechnical Stability Exhibit,and a check 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 /> 8 1/2"X I I"or 8 1/2"X 14"size. To expedite 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 requested below. <br /> 1. Applicant/operator or comoanv name(name to be used on permit): Blue Mountain Stone Inc. <br /> 1.1 Type of organization(corporation,partnership,etc.): S Incorporated <br /> 2. Operation name(pit.mine or site name): Phillips Stone CO <br /> 3. Permitted acreage(new or existing site): 9.9 permitted acres <br /> 3.1 Change in acreage(+) 33.1 acres <br /> 3.2 Total acreage in Permit area 43 acres <br /> 4. Fees: <br /> 4.1 New Application $2,696.00 application fee <br /> 4.2 New Quarry Application $3,342.00 quarry application <br /> 4.4 Amendment Fee $2,229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $2,696.00 conversion fee <br /> 5. Primary commoditie(s)to be mined: Sandstone Steppers Flagstone Slabs <br /> 5.1 Incidental commoditie(s)to be mined: 1. NSA - lbs/Tons/yr 2. NSA / lbs/Tons/yr <br /> 3. NSA / lbs/Tons/vr 4. NSA / lbs/Tonslvr 5. NIA / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: Construction, landscaping and decorative use <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: NIA <br />