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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 /> DIVISION OF <br /> Phone:(303)866-3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> —&— <br /> SAFETY <br /> LIMITED L 1PACT OPERATION (110(2)) RECEIVED <br /> RECLAMATION PERMIT <br /> APPLICATION FORM 2 d 2024 <br /> ColoradoMAY Division of Reclamation, <br /> MMining and Safety <br /> CHECK ONE: New Application(Rule l 4) El Conversion Application(Rule 1 l"1) <br /> Permit M- - (provide for conversions of existing permitN) <br /> The application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br /> form: (2) Exhibits A-J. any required sections of Exhibit S and Geotechnical Stability Exhibit. as required by the Office. and outlined in <br /> Rules 6.1. 6.2. 6.3, 6.4.19 and 6.5: and (3) the application fee. When you submit your application, be sure to include one(1) signed and <br /> notarized original and one(1)copy of the application form. two(2)copies of Exhibits A-J,appropriate sections of 6.4.19 Exhibit S and 6.5 <br /> (Geotechnical Stability Exhibit), as required,and a check for the application fee descnbed under(4)below. Exhibits should not be bound <br /> or in a 3-ring binder: maps should be folded to 5 1'2" X I I" or 8 1 2" X 14" size. lo expedite processing.please pro%ide the information <br /> 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): 6 P5 b-fir'/1Pj21N G <br /> 1.1 Type of organization(corporation.partnership,etc.): S- CcAP <br /> 2. Operation name(pit,mine or site name): /I/Kj3.t /?d(,fff b f +t' Z <br /> 3. Permitted acreage(new or existing site): /0 permitted acres <br /> 4. Fees: <br /> 4.1 Neu Application 51,006.00 application tee <br /> 4.2 Amendment Application(from 1 10(2)) <br /> 4.3 Conversion Fee(from 110d to 110(2).(Rule 1.11.2(2)) 51.725.00 conversion fee <br /> 5. Primary commoditie(s)to be mined: 6.19Lp 'd REg <br /> 6. Name of owner to the surface of affected land: J' i//1/ 14) 602.0,5/e//6PS Eidf ,ep,e1Ses �.✓G <br /> 7. Name of owner to the subsurface rights of affected land: ,3 A./4 <br /> S. Type of mining operation: EI Surface LJ Underground LI In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />