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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY RECEIVED <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 APR 1 5 2024 COLORADO <br /> Denver,Colorado 80203 DIVISION OF <br /> Phone:(303)866.3567Colorado Division of Reclamation, RECLAMATION <br /> FAX:(303)8324106Mining and Safety M IN I NO <br /> SAF TY <br /> DESIGNATED MINING <br /> LIMITED IMPACT(110d)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: El <br /> New Application(Rule 1.4) 0,Z:, [ Amendment Application(flute 1.8 or 1.10) <br /> Conversion Application(Rule 1.1 I)Permit#M- 23 - rovide for Amendments and Conversions of existing permits) <br /> The application for a Limited Impact(110d)Designated Mining Operation Reclamation Permit contains three major parts: (1)the application <br /> form;(2)Exhibits A-J,Exhibit L,Exhibit T,the Geotechnical Stability Exhibit,the Emergency Response Plan,and Addendum 1,as required by <br /> the Office,and outlined in Rules 6.1,6.2,6.3,6.4.20 6.5.8,and 1.6.2(1)(b);and(3)the application fee. When you submit your application,be sure <br /> to include one(1)signed and notarized Original and one(1)copy of the application form,two(2)copies of Exhibits A-J,Exhibit L,Exhibit T,the <br /> Geotechnical Stability Exhibit(Rule 6.5),the Emergency Response Plan(Rule 8),and Addendum I(Rule 1.6.2(1)(b)),as required,and a check for <br /> the application fee described under(4)below. Exhibits should WI be bound or in 3-ring binders;maps should be folded to 8 2"X I 1"or 8 2" X <br /> 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 described below.> <br /> 1. Anglicant/operator or company name(name to be used on nermit):7 // l3dt�*S L r4fldlp ,LL L <br /> LI Type of organization(corporation,partnership, <br /> <br /> 2. Operation name(nit.mine or site name): f ,GA1E lie <br /> PIT3. Permitted acreage(new or existing site): Ir 79 permitted acres <br /> 3.1 Change in acreage(-,-) — 0-acres <br /> Total Acreage in Permit Area 9l. 7 acres <br /> 4. Fees: (Rule 1.5) <br /> 4.1 New Application $2,875.90 application fee <br /> 4.2 Amendment Fee(operations existing as of 06/30/94) $1.725.00 application fee <br /> 4.3 Amendment Fee(operations permitted from 07101194) S2.300.00 application fee <br /> 4.4 After July 1,1995,to convert a 110(1),110(2)or a 110 to a 110(d),a new application form fora 1 I Od must be submitted,along <br /> with an application fee of 52.875.00(Rule 1.11.2(2))). <br /> 5. $rimary commodities to be mined: IQOC-K cv2C /C(36a1A A9S8 <br /> 6. Tyne of mining operation: IE Surface E1 Underground .l 1n-situ <br /> • <br /> Office ofOffice of <br /> Mined Land Reclamation Denver • Grand)unction • Durango Active and Inactive Mines <br />