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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303)632-8106 <br />CONSTRUCTION MATERIALS <br />REGULAR (]12) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a F6e Number Already Assigned to this Operation <br />Permit # M -- _ (Please reference the file nmmber clurently assigned to this operation) <br />_~ New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Applicafion (Rule 1.11) <br />Permit # M -_ -^ (provide far Amendments and Conversions of existing petlniU) <br />+ 291.5 <br />- pzrmiued acres <br />The application for a Canstmction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) the application form; <br />(2) Exhibits A-S, Addendum ], a~ sections of Exhibit 6.5 (Geotechnical Stability Exhibit; a~ (3) the application fee. When you submit your <br />application, be sate to inchlde one (1) complete siffied and notarized IVORY ORIGINAL and one (1) copy of the completed I~ application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8112" X 1 ]" or 8 1/2" <br />X 14" size. To expedite processing, please provide the information in the format and order described m this form. <br />CiE1VERAI.OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Applicant/operatorotcomoanvname(nametobeuaedonpermitl: A99regdte Industries - 41CR, Inc. <br />] . i Type of organization (corporation, partnership, etc.): co r po ra t i o n <br />L2 LRS. Tax LD. No. or Social Security Number: 84-0404340 <br />2. Operation name (pit. mine or site Hamel: TUCSOn $OUth R250U rCe <br />3. Peemitted acreage (aew or esistins sirel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage is Permit area <br />4. Fees <br />Bill Chvens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cattany <br />Acing Division Director <br />acres <br />+ 291:5 <br />- acres <br />4.1 New Application $2,344.00 application fee <br />4.2 New Quarry Applicaion $2 906.00 quarry application <br />4.4 Amendment Fee 51.938.00 amenrlmf:ai fee <br />4S Conversion to 112 operation (set by statute) 52.344.00 conversion fee <br />~. Primaryeammoditie(sltobemined: sand gravel <br />5.1 Incidental commoditie(s)-[o be mined: 1. 901 d _ 5 g~/'1'ons/vr 2. / Ibslfons/vr <br /> <br /> 3. / Ibs/Tons/vr 4. / Ibs/I'ons/vr 5. / Ibs~Tons/vr <br />5.2 Anticipated end use of primary commoditie(s)to be mined: COnStrUCtlOn I!Id to r'Ia1S <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: n/a <br />RECEIVED <br />N~~ Z Z 2(f~4 I M I NSE RA L S <br />Division of Minerels and Geology ( G E O L O G Y <br />RECLAMATION <br />MI NING•SAFETY <br />