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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 C,N-2 <br /> Denver,Colorado 80203 H R1/ZTT C O L O R A D O <br /> D i V i S i O N OF <br /> Phone(303)866-3567 <br /> RECLAMATION <br /> FAX:(303)832-8106 <br /> HARD ROCK/METAL MINING MINING <br /> &— <br /> REGULAR OPERATION(112) SAFETY <br /> RECLAMATION PERMIT APPLICATION FORM <br /> RECEIVED <br /> CHECK ONE: 111 There is a File Number Already Assigned to this Operation <br /> NOV 2 i 2'074 <br /> New Application(Rule 1.4.5) Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) Colorado Divis,; )of,P c{amation, <br /> Permit#M- 2016 _ 081 _ (provide for amendments and conversions of existing permits) Mining and Safety <br /> The application for a Regular Operation Reclamation Permit contains three major parts:(1)the application form;(2)Exhibits A-S, <br /> Geotechnical Stability Exhibit and Addendum 1;and,(3)the application fee. When you submit your application,be sure to include <br /> one(1)completed,signed and notarized gray original and one(1)copy of the completed application fonn,two(2)copies of Exhibits <br /> A-S,the Geotechnical Stability Exhibit,and Addendum 1, and a check for the application fee described under Section 4 below. <br /> Exhibits should NOT be bound or in a 3-ring binder;maps should be folded to 8 1/2"X 11"or 8 1/2"X 14"size. To expedite <br /> 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 name: AuPt Industries <br /> 1.1 Type of organization(corporation,partnership,etc.): LLC <br /> 2. Operation name(pit,mine or site name): West Side Placer <br /> 3. Permitted acreage(new or existing site): 9.9 permitted acres <br /> 3.1 Change in acreage(+or-) 70 acres <br /> 3.2 Total acreage in Permit area 79.9 acres <br /> 4. Fees: <br /> 4.1 New Application _$2.156.00 application fee <br /> 4.2 New Quarry Application $2,674.00 quarry application <br /> 4.3 Milling Application(Non-DMO) $3,565.00 milling application <br /> 4.4 Amendment Fee $1,783.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) $1,725.00 conversion fee <br /> 5. Primary commoditie(s)to be mined: Gold, Monazite, Ilmenite, and Zircon <br /> 6. Name of owner of surface of affected land: Colorado State Land Board <br /> 7. Name of owner of subsurface rights of affected land: Colorado State Land Board <br /> If 2 or more owners,refer to Exhibit O. <br /> 8. Type of mining operation: X Surface Underground In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />