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<br />III IIIIIIIIIIIIIIII <br />~t -w1 <br />tip' _. [~G , ~-: sp• ~ <br />+I~`~ ~ ~~ ~ 1C,~~ DEPARTMENT OF NATURAL RESOURCES <br />'1i\ _~ ~-_•L; Uavitl H. Garcn~s E•ewdve Dnscrur <br />\~e_~, ~ MINED LAND RECLAMATION DI1 <br />DAVID C. SHELTON, Olr~ctor <br />-, r... <br />a ¢hn~ ` <br />tl n L R~ym :~: ~ ~{,F~ . : ,jJ <br />(.,[•ve7h oi~., ~ ~~, t . ,. <br />~., ~,. <br />~~_,-~~ ~•"' Application Form for a Permit <br />(9a6 t° <br />F [g 2 1 Lon duct Coal Mining in Colorado <br />p, ~ l?;l; <br />.n .....:,: I <br />AG~n`]acat,ion..fq.~~n~'uct surface or uneergrouna coal mining activities or other <br />"',:~surf~acertioal •mining and reclamation operations in Colorado pursuant t0 L.R.S. <br />x`'`19"73, 34-33-101, et she . <br />For an application to be deemed complete by the Division pursuant to C.k.S. <br />1973, 3a-33-103{5) ar~d Rule 1.04(30), an a~rplicant rnust: (1) supply all <br />information as specified on this aoplication form; (2) subnit five <br />reproducit~le copies of the permit application wittl original signatures; and <br />{3) pay Lhe appropriate fee required by Rule [.01.6. <br />Please note that this form is only a 7istin~ of <br />anc apes not constitute a checklist of detailed <br />requirements. A finding of completeness she,,ld <br />adequacy of an application. Additional infcr;na <br />may be required for adequacy depending upon the <br />application. <br />general cateoory requirements <br />permit application <br />not be interpreted to imply <br />lion not 175tEd on this form <br />individual circumstances of an <br />This form consists of two major parts: (1) a Section entitled (General <br />Operation Information and (2) a section entitled Application Requirements. <br />Specific instructions for filling in the necessary information for each <br />section appears immediately held„ the title of each section. <br />GENERAL OPERATIOIr' INFORMATION <br />Type or print clearly the appropriate information as listed below. <br />Supplemental sheets may be used as necessary, such sheets must be attached to <br />the form and referenced or keyed to the numbers on the form. <br />1. Name of Operation <br />(Pit, mine or site name) <br />2. Name of Applicant <br />(Name to be used on permit - <br />the Permittee) <br />FYuita Mine Canplex <br />American Shield Opal Company (formerly <br />lbrchester Coal Carg:any) <br />"t a. Hddress and phone number of 5670 S. Syracuse Circle, Suite 414 <br />local offices Englewood, Colorado 80111 <br />2b. Address and phone number of 5670 v. Syracuse Circle, Suite 914 <br />general offices. Englewood, Colorado 80111 <br />423 Centennial Bulldinp, 1313 Sherman Street Denver, Colorado 80203 Tel. (307) 866.3567 <br />