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91/4 DNP COLORADO <br /> CO Division of Reclamation,Mining and Safety RECEIVED M-2025-050 <br /> Deparrr,ent Jt`+arum!Qesourecx BEH/ZTT <br /> 1313 Sherman Street, Room 215 OCT 28 2025 <br /> Denver,CO 80203 <br /> olorado Division of Reclamation, <br /> Mining and Saftey <br /> LIMITED IMPACT OPERATION(110(1)) <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> CHECK ONE: I ew Application El Conversion Application(Rule 1.11) <br /> Permit#M- � — (provide for conversions of existing permits) <br /> The application for a Limited Impact 110(1) Mining Operation Reclamation Permit contains three major parts: (1)the application form; <br /> (2)Exhibits A-J, any required sections of Exhibit S and Geotechnical Stability Exhibit,as required by the Office., and outlined in Rules <br /> 6.1, 6.2, 6.3,and 6.5; and(3) the application fee. When you submit your application, be sure to include one (1)signed and notarized <br /> original and one(1)copy of the application form,two(2)copies of Exhibits A-J,and 6.5(Geotechnical Stability Exhibit),as required,and <br /> a check for the application fee described under(4)below. Exhibits should not be bound or in a 3-ring binder;maps should be folded to 8 <br /> 1/2"X 11"or 8 1/2" 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 the space provided,all information described below <br /> 1. Applicantloperator or company name(name to be used on the permi <br /> t): �1�T .--V / , G :S____ <br /> 1.i Type of organization(corporation,partnership, <br /> ++etc):'_. L. G� <br /> 2. Operation name(pit,mine or site name): __.L1I ll l.t-t ( k, 72.___"AI L.J Y <br /> Permitted acreage(must be S acres or less): 0i � ,�'- �� _peiutitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 4.2 Amendment Application $661.00 amendment fee <br /> 4.3 Conversion Fee(from 1 l0(2)to 110(1),(Rule 1.11.2(2)) $288.00 conversion fee <br /> 5. Primary commodities)to be mined: N 'x , ,L� , __ �j i2e0er-!-__PRexM <br /> 6. Name of owner to the surface of affected land: 30CW__NL/4 g 711 -- _$04-6 719,444. '4 <br /> 7. Name of owner to the subsurface rights of affected land: /f'1 .___..________ <br /> 8, Type of mining operation: )C Surface El Underground nPlacer <br /> \9 <br /> 1313 Sherman Street, Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us I • <br /> John W. Hickentooper,Governor l Mike King, Executive Director I Virginia Brannon,Director • • <br />