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M- ~oc7 ~ -~~7 <br />fPrA~' ~~:`~ <br />R~~'~'. <br />~V~.~ 9 a\SH~aoea~a®~ <br />Ot,(tstoQ° <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />RECEI~/ED <br />JUN 1 y 2006 <br />Division of Minerals enA fieolo~y <br />CHECk ONE: There is a File Number Already- Assigned to this Operation <br />Permit # M -_ _ _ (Please reference the file number currently assigned to this operation) <br />~, Nee Application (Rule 1 4.5) Amendment Application (Rule L IO) <br />Conversion Application (Rule L 11) <br />Permit # M - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (t t0j Operation Reclamation Permit contains three major party. (i) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1){b); and (3) the application fee. When you submi[your application, be <br />sure to include one (I) complete siened and notarized ORIGINAL and one (I) copy' of the completed application form, h~-o (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application tee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps shotild be folded to 8 1 /2" X <br />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. AnnUcantfonerator or company name (name to be used on permit): ~/4' T ~QLf-{r~N iy ~/I~C, <br />r <br />t <br />L 1 T)~pe of oreanization (corporation, partnership, e/tc.):1 CO £ ipaL'A'~r ,~1 <br />2. Onerotion name (nit, mine or site name): l ill ~ LL-j /1 T <br />3. Permitted acreage (new or esistire~ site): ~1, s perntitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Pemtit Area e~. s acres <br />4. Fees: <br />4.1 ~..;:: Application: .1,094 QO application fee <br />Amendment Fee (C. R.S. 34-32.5-125([1)): .719.00 application fee <br />4.2 Conversion Fee (from I I Od to 1 l0 $875.00 com-ersion fee (Rule L 1 L2(2)) <br />5. Priman~ commoditie(sl to be mined: 1 T i-(!s <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/I'ons/rr 2. / lbs/Tons/r~r 3. / lbs/1'onsh~r <br />4. / Ibsll'ons/cr i. / Ibs/Toaskr <br />52 Anticipated end use of priman~ comnrodi[ie(s) to be mined: .~ U i`, . 3~r 25~~ <br />Anticipated end use of incidental conunoditie(s) to he mined: 'y ask <br />