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DRMS Application Form <br /> STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MIRING AND SAFETY <br /> Department of Natural Resources REcEPiED 1313 Sherman St..Room 215 <br /> Denier.Colorado 80203 C O Li O A D O <br /> Phone:(303)SW-3567 u v � t o y o r <br /> FAX:(303)832-8t06 U� 112025 FIEML N N ON <br /> plamion 0f Red a�0n, SAFETY` <br /> no\coasTRrrTION CIA <br /> oca nkuutining and Safety <br /> LL\IITED IMPACT(110)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> M-2025-034 <br /> CHECK ONE. El There is a File Number Already Assigned to this Operation <br /> TJ1/THM <br /> Permit a M - - _ (Please reference the file number enneady assigned to this operation) <br /> New Application(Rule 1.4.5) fl_Amendment Apphcation(Rule 1.10) <br /> C onyersion Application(Rule 1.11) <br /> Permit I M - - - (provide for Amendments and Conrersioas of existing permits) <br /> The application for a Construction Materials Limited Impact(110)Operation Reclamation Permit contains three major part:: t 1)the <br /> application form;(2)ExhibitsA-1,Exhibit L.Addendum 1,any sections of Exhibit 6.5 and Geotechnical Stability Exhibit,as required by <br /> the Office,and outlined in Rules 6.1.6.2.6.3,6.5.and 1.6.2(1 Xb);and(3)the application fee. When you sauna your apphcation.be:sir e <br /> to include one(1)complete limed and notarized ORICLNAL and one(1)copy of the completed application form two(2)copse: of <br /> Exhibits A-J.Exhibit L,Addendum 1.and appropriate sections of 6.5(Geotechnical Stability Exhibit).as required,and a check for the <br /> application See described under(4)below. Exhibits should NOT be bound or in a 3-ring binder;maps should be folded to S I.2•X 11-or S <br /> 12"X 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 t e space provided, ALL information described below. <br /> 1. Applicant'operator or company name(name to be used on permit): Thomas Wade O'Rourke <br /> 1.1 Type of organization(corporation.partnership.etc.) Sole Proprietor <br /> 2. Operation name(pit,mine or site name): Granger Pit <br /> 3. permuted*create(new or existiat site): 9.99 permitted acres <br /> 3.1 Change in acreage(+) acres <br /> 3.2 Total Acreage in Permit Area 9.99 acres <br /> 4. eel,: <br /> 4.1 New Application t 1'S 8 00 application fee <br /> Amendment Fee(CRS.34-32.5-125(U)): S827 OQ application fee <br /> 5. Primers-commoditiie(s)to be mined: Sand Gravel <br /> 5 1 Incidental commoditie(s)to be mined: ]. IbsTons`vr 2. lbs'Tons'vr 3 IbsTons'vs <br /> 4. 1bs•Tons yr 5 Ibs•Tons'vr <br /> 5.2 Anticipated end use of primary commodities)to be mined: Construction and Road Maintenance <br /> Anticipated end use of incidental commodities)to be mined: <br /> 01 APRIL 2025©WASTELINE, Inc.All Rights Reserved. Page 3 of 47 <br />