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DNR COLORADO <br /> Co Division of Reclamation, <br /> • Mining and Safety M-2025-065 <br /> Department of Natural Resources ACY/TH M <br /> • <br /> 1313 Sherman Street, Room 215 <br /> Denver,CO 80203 <br /> LIMITED IMPACT OPERATION(110(1)) RECEIVED <br /> RECLAMATION PERMIT <br /> APPLICATION FORM DEC 2 2 2025 <br /> DIVISION OF RECLAMATION <br /> CHECK ONE: 0 New Application ❑ Conversion Application(Rule 1.11) MMHG AND SAFETY <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 pacts: (I)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;at (3)the application fee. When you submit your application, be sure to include one(I) signed and notarized <br /> original and one(1)copy of the application form,two(2)copies of Exhibits A-1,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 INFORMATIO*' <br /> Type or print clearly,in the space provided,all information described below <br /> Applicant/operator or company name(name to be used on the rmit): 'C,leN0.e I 54 kk)Cf-T <br /> Type of organization(corporation.partnership,etc.): RO Ul1 ex.` f RO CKNn ovK s <br /> 2. Operation name(pit,mine or site name): J 0.CY-ck\opt <br /> Lj C� <br /> 3. Permitted acreage(must be 5 acres or less): 1.9 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 4.2 Amendment Application S66100 amendment fee <br /> 4.3 Conversion Fee(from 110(2)to 110(1),(Rule 1.11.2(2)) $288,00 conversion iec <br /> 5. Primary commoditie(s)to be mined: Q 0.`c DAC t�'� t p'1`t 1/L c INS t(\2 Ccl\s eYkG CIA \n <br /> 6. Name of owner to the surface of affected land: 13 L/V\ <br /> 7. Name of owner to the subsurface rights of affected land: B'L <br /> 8. Tyne of mining operation: Surface ❑ Underground ❑Placer <br /> ihv. Y• <br /> 1313 Sherman Street,Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state.co.us <br /> John W.Hickenlooper,Governor I Mike King,Executive Director I Virginia Brannon,Director +.iri76 <br />