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S ~~~~_ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Uepanment of Natural Resources <br />111 3 Sherman 51., ROO }1,5 <br />Denver, Colonrio <br />Phnnc: (SU 1LAiG'6 <br />Fq ~:13U ~--8106 2QQo <br />MH~ MA,~CL\'~~e~~Y <br />REGULAR (212) <br />RECLAMATION PERMIT <br />FORM <br />--- /~'~ <br />~~ <br />DEPART.ME(VI' OF <br />~- _ ~is NATURAL <br />,. _ RESOURCES <br />kov Romer <br />Governor <br />dames 5. lochhead <br />Ezecuuee D:recor <br />atichaei B. Long <br />Die ismn Director <br />CHECK ONE: ~'~ Nex Application (Rule 1.9.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # /~~~_ (provide for s^~~++~ents and Conversions of existing -~ <br />permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sinned and notarized IVORY ORIGINAL and four (9) <br />copies of the completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br />described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps <br />should be folded to 8 1/2" X 11" or 6 1/2" X 14" size. To expedite processing, please provide <br />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 requested belox. <br />1. Applicant/operator or company name (name to be used on <br />AGRI-DLD. LLC Hermit): <br /> 1.1 Type of organization (corporation, partnership, etc.): LLC <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Oceration name (pit, mine or site name): AGRI-DLD Gravel Pit <br />3. Permitted acreage (Hex or existing site): 76.7.7 permitted acres <br /> 3.1 Change in acreage (+) N/A acres <br /> 3.2 Total acreage in Permit area 76.27 acres <br />9. Fees: <br /> 9.1 New Application 51.675.00 application fee <br /> 4.2 New Quarry Application 52,325.00 q uarry application <br /> 9.3 Milling Application (Non-DMO) 53.100.00 mi lling application <br /> 4.9 Amendment Fee S1.550.00 amendment fee <br /> 9.5 Conversion to 112 operation (set by statute) 51,875.00 conversion fee <br />5. Primar y commoditie(s) to be mined: gravel aggregates <br /> 5.1 Incidental commoditie(s) to be mined: 1. NA ~bs/ Tons/vr <br /> 2. / lbs/Tons/vr 3. / lbs/ Tons/vr <br /> 9. / lbs/Tons/vr 5. / lbs/ Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: road COnstruCtiOn <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mired: NA <br />