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STATE OF COLOFADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY RECEIVED <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 S E P 0 3 2024 <br /> Denver,Colorado 80203 D� I SOI o AN of <br /> Phone:(303)866.3567 Colorado Division of Reclamation, RECLAMATION <br /> FAX:(303)832-8106 Mining and Safety MINING <br /> —&— <br /> SAFETY <br /> DESIGNATED MINING <br /> LIMITED IMPACT(110d)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> AM-3 <br /> CHECK ONE: New Application(Rule 1.4) D✓ Amendment Application(Rule 1.8 or 1.10) DMC/THM <br /> Conversion Application(Rule 1.1 1) <br /> Permit#M- 1''.'�. 021)- (provide for Amendments and Conversions of existing permits) <br /> The application for a Limited Impact(11 Od)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 /> theOffice,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 1(Rule 1.6.2(1)(b)),as required,and a check for <br /> the application fee described under(4)below. Exhibits should NOIbe bound or in 3-ring binders;maps should be folded to 8 2"X 11"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. Applicant/operator or company name(name to be used on permit): ALSH LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): Limited Liability Company <br /> 1.2 I.R.S.Tax ID No.or Social Security Number: <br /> 2. Operation name(pit,mine or site name): Lucky Strike Mine & Mill <br /> 3. Permitted acreage(new or existing site): 8.0 _permitted acres <br /> 3.1 Change in acreage(+) 0 acres <br /> Total Acreage in Permit Area 8'0 acres <br /> 4. Fees: (Rule 1.5) <br /> 4.1 New Application S2,875.00 application fee <br /> 4.2 Amendment Fee(operations existing as of 06/30/94) S1.725.00 application fee <br /> 4.3 Amendment Fee(operations permitted from 07/01/94) $2,300.00 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 for a 11 Od must be submitted,along <br /> with an application fee of$2,875.00(Rule 1.1 1.2(2)). <br /> 5. Primary commodities to be mined: Gold, silver <br /> 6. Type of mining operation: 0 Surface E.Underground L In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />