PERMFILE44600

• Permit No: M2004067
• IBM Index Class Name: Permit File
• Doc Date: 9/20/2005
• Doc Name: 4th Adequacy Review
• From: DMG
• To: Paul Gesso
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
7373 Sherman St, Room 275 -
Denver, Colorado 80203
Phone: [phone] CONBTRUCTION MATERTALS
FAX: [phone] REGULAR (112) OPERATION
RECLAMATION PERMIT APPLICATION FORM
CHECK ONE: There fB a File Number Already Assigned to this Operation
Permit # M -_-_ _ (Please reference the file number cturently assigned to this operation)
New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10)
_ Converskn Application (Rule 1.11)
Permit # M -_ _ (provide for Amendments and Converoions of existing permits)
COLORADO
DIVISION O F
MINERALS
GEOLOGY
AF CLANATION•NINING
FAf ETY•SCIENCE
Bill Owens
Governor
Russell George
Executive Director
Ronald W. Cottony
Division Director
Natural Resource Trustee
The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three majorparts: (1) the application form;
(2) Exhibits A-S, Addendum 1, a~ sections ofExhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fce. When you submityour
applicatioq be sure to include one (1) complete siated and notarized ORIGINAL and one (1) copy of the completed applicationfonq two (2)
copies of Exhibits A-S, Addendum 1, appropriate sections of6.5 (Geotechnical StabilityFachibit, and a check for the application fee de~ribed
under Section (4) below. Exhibits should NOT be bound or in a 3-ring bindcr; maps should be folded to 8 1 /2" X 1 I" or 8 I!2" X 14" size. To
expedite processing, please provide the information in the format and order descnlted in this form.
GENERAL OPERATION INFORMATION
Type or print ckarly, in the apace provided, ALI, urformatlon requested below.
1. AoplicanUocerator or rnmnanvname (name to be used on cermit):
1.1 Type of organization (cgrporatioq partnership, etc.):
2. Operation name fait, mine or site name):
3. Permitted acreage (sew or e:istlae site):
3.1 Change in acreage (+)
3.2 Tots] aLxeage in Permit area
4. Fetes:
4.1 New Application
4.2 New Quarry Application
4.4 Amendment Fee
4.5 Conversion to 112 operation (set by statute)
5. Primary commoditie(s) to be mined:
5.1 Incidental commoditie(s) to be mined: ] . - lbsrfonslvr
3. / lbs/'I'onsi~r 4. / lbs/Tons/vt
5.2 Anticipated end use of primary commoditie(s) to be mined: _
5.3 Anticipated end use of incidental commoditie(s) to be mined:
permitted acres
acres
$2.344.00 application fee
$2.906.00 quarry application
51.938.00 amendment fee
$2.344.00 conversion fee
2. / lbs(fonsNr
5. / Ibs/1'ons/vr
Office of Office a( Colorado
Mined Land Reclamation Active and Inactive Mines Geological Survey