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ue�fc t- � C .r`— <br /> ��� Cvt4( P-) LT �2 - -STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources E C E I V E <br /> 1313 Sherman St.,Room 215 <br /> Denver,Colorado 80203 DEC 2 0 2022 D 0 r SSr O N o° <br /> Phone:(303)866-3667 RECLAMATION <br /> FAX:(303)832-8106 <br /> MINING <br /> Paf <br /> SAFETY <br /> CikhlQa...r <br /> CONSTRUCTIONv��J ---MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PER VW APPLICATION FORM <br /> CHECK ONE:t_.L_ There is a File Number Already Assigned to this Operation <br /> P 't# M _ (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> ✓ Conversion Application(Rule 1.11) <br /> Permit# M 1 )91 081 (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 application <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,AA"information requested below. <br /> 1. Applicaut/operator or company name(name to k used on Hermit): Russell Van Egmond <br /> 1.1 Type of organization(corporation,partnership,etc.): individual <br /> 2. Operation name(pit.mine or site name): Van Egmond Stone <br /> 3. Permitted acreagg(new or existing site): 10 permitted acres <br /> 3.1 Change in acreage(+) 10 acres <br /> 3.2 Total acreage in Permit area 20 acres <br /> 4. &ff. <br /> 4.1 New Application $2.696.00 application fee <br /> 4.2 New Quarry Application S3.342.00 quarry application <br /> 4.4 Amendment Fee $2229.00 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. Gravel <br /> 5.1 Incidental commodities)to be mined: 1. N/A is/Tonsfvr 2. / lbs/Tons/vr <br /> 3. / Ibs/TQWa 4. _ / lbs/TonsNr 5. / 1bs/Tons61 <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: t>t-t Yt,-3 0-0-6 <br /> 5.3 Anticipated end use of incidental commodities)to be mined: N/A <br />