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. ~Tt~TE OF COLORADO ' <br />• DIVISION OF MINERALS AND GEOLOGY ~GV~1~ <br />Drpartmem of Natural Resources G rI <br />I;1 4 Sherman Sr., Ruom ?li ~p p u r) d.00~ D I V I S I O N O F i <br />Denver, Culur.tdo HU2UJ l t~ <br />Phone: 0071 8hb356% ~eu',o9'1 MINERALS <br />FnxisoJinJ.-ninb ~NSWnpIMtOytanl' G E O L O G Y• <br />R E C L A M A T I O N <br />CONSTRUCTION MATERIALS MIN ING•SAFETY ~ <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM B~II Owrns <br />Governor <br />Qep E. Walther <br />E.ecmrve Dnenor <br />CHECK ONE: New A licazion Rule L4.5 Amendment A lica[ion Rule 1.10 ichael 8. Loop <br />PP ( ) PP ( ~imsion Dueclor <br />Conversion Application (Rule I.I 1) <br />Permit # m ~-^~~~ (provide for Amendments and Conversions ofexisting permits) <br />The application for a Construction Mazerials Regular 1 l2 Operation Reclamation Permit contains three major parts: (I) the applicarion form; <br />(2) Exhibits A-S, Addendum 1, arty sections of Exhibit 6.5 (Geotechnical Stability Exhibit and (3) the application fee. When you submit your <br />application, be sure to include one (I) complete sieved and notarized IVORY ORIGINAL and four (4) copies of the completed No <br />application form, five (5) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 I/2" X 11" or 8 112" 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, io the space provided, ALL ioformAatiou requested below. <br />I. Aoplicant/ocerator or comoanv name (name to be used on oermitl: M•n1 • ~oNG~~~ <br />I.I Type of organizarion (corporation, partnership, etc.): ~R~t'~ ~T 1 Ofd <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: ~"' ~~9 <br />2. Operatiou usme (nit, mine or site Hamel: Mot.lUMC~1' ~ 1 ~IK GRA~~. ~ 4 1 <br />3. Permitted acreatte tnew or existioe sitel: ~J7 t'i~ permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit area 37 • ~o acres <br />4. Fees: <br />4.l New Application 1875.00 application fee <br />,` 4.2 New Quarry Application 52.325.00 quarry application <br />43 Milling Application (Non-DMO) 33.100.00 milling application <br />4.4 Amendment Fee $1.550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $1.875.00 conversion fee <br />5. Primary commoditie(sl to be mined: .~~ ~2AKC1- <br />5.1 lncidental commoditie(s) to be mined: I. -~• Ibslfons/vr 2 / Ibs/Tons/yr <br /> 3. ! lbs~i'onslvr 4. f Ibsfl'onslvr 5. 1 1bslConslvr <br />~ • 5.2 Anticipated end use of primary commoditie(s) [o be mined: ~NJ~~~IV I~iQ~/.4( $ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: h/OI~lE <br />