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! COLORADO <br /> Division of Reclamation, RC��t�� <br /> Mining and Safety G v <br /> Departrnent of Natural Resources Za��1313 Sherman Street,Room 215 <br /> Denver,Colorado 80203 f v <br /> 00 <br /> CONSTRUCTION MATERIALS pIVtS10N OF R TY M NSRALS <br /> M1N1NG&SAFE <br /> SPECIAL OPERATION 111(1)(b) <br /> RECLAMATION PERMIT APPLICATION FORM <br /> The application for a Construction Materials Special I I I Operation Reclamation Permit contains four major parts: (1) the <br /> application form;(2)Exhibits A-L,Addendum 1,and any sections of Exhibit 6.5(Geotechnical Stability Exhibit),as required <br /> by the Office,and outlined in Rules 6.1,6.2,6.3, 6.5,and 1.6.2(1)(b); (3)the application fee; (4)the Performance Warranty <br /> and Financial Warranty. <br /> When you submit your application,be sure to include one completed.,signed and notarized ORIGINAL and one copy of the <br /> completed application form, two copies of Exhibits A-L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical <br /> Stability Exhibit), as required, a check for the $400.00 application fee, and the fully executed Performance Warranty and <br /> Financial Warranty. Exhibits should NOT be bound or in 3-ring binders;maps should be folded to 8 '/2"X I V or 8 ''/z"X 14" <br /> 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 described below <br /> 1. Applicant/operator or company name(name to be used on the permit): <br /> Crossfire Aggregate Services LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Colorado LLC <br /> 2. Operation name(pit,mine or site name): Kelly's Pond Project <br /> 3. Permitted acreage:(must be 30 acres or less) 4.0 Permitted Acres <br /> 4. Fees: <br /> 4.1 New Application $400.00 Application Fee <br /> 5. Primary commodities)to be mined: Sand and gravel(construction materials) <br /> 6. Name of owner to the surface of affected land: Dan&Kelly Ferguson, 12740 SH-151 Arboles,CO 81121 <br /> 7. Name of owner to the subsurface rights of affected land: Dan&Kelly Ferguson <br /> 8. Location information: The center of the area where the majority of mining will occur: <br /> COUNTY: Archuleta <br /> PRINCIPAL MERIDIAN(check one): F] 6th(Colorado) II 10th(New Mexico) a Ute <br /> SECTION(write number): S 21 <br /> TOWNSHIP(write number and check direction): T 33 ✓ North South <br /> RANGE(write number and check direction): R 5 East ✓ West <br /> QUARTER SECTION(check one): W—NE F-1_ NW SE SW <br /> QUARTER/QUARTER SECTION(check one): `-1 NE _Q NW � SE ✓�SW <br /> 1313 Sherman Street, Room 215,Denver, CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us <br /> \}1876} <br />