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<br />~ STATE OF <br />COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Na[uraFResources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />RECEIVED <br />MAR 13 1998 <br />CONSTRIICTION MATERIALS ~IYI$IOf10) MIfI6Fd)S & GBOIOJy <br />LIMITED IMPACT (110) OPERATION <br />~'~ <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Governor <br />RECLAMATION PERMIT APPLICATION FORM lames 5. Lochhead <br />Executive Director <br />~i - q~ oa ~ Michael B Long <br />Division Director <br />CI-IECK ONE: ~ Nem Application (Rule 1.4) Amendment Application (C.R.S. 34-32.5-110) <br />Conversioa Application (Rule 1.11) <br />Permit'# - -_ (provide for Amendments and Coayersions of <br />existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit <br />contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, <br />any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and <br />outlined in Rules 6.1, 6.2, 6.3, 6. 5, and 1.6.2(1)(b); and (3) the application fee. when you <br />submit your application, be sure to include one (1) complete"sioned and notarized IVORY ORIGINAL <br />and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A-J, <br />Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as <br />required, and a check for the application fee described under (4) below. Exhibits should NOT be <br />bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To <br />expedite processing, please provide the information in the format and order described in this <br />form. <br />-------------------------------------------------------------------------------------- <br />-------------------------------------------------------------------------------------- <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />-------------------------------------------------------------------------------------- <br />1. Applicaat/operator or compaaY name (aame to be used oa permitl: <br /> (3+(3 ~Xe,t~VA-'f1n1,~ ~ LNG. I"Yl- °/~~ bZ Y <br /> 1.1 Type of organization (corporation, partnership, etc.): ~/Q~A12~4'l/OAS <br /> 1.2 I.R.S. Tax ID No. or Social Security Number: <br />" S <br />"><~ ®6 O <br />~~ <br />{ <br />2. ~/ <br />Operation same (pit, mine or site aame) : R/~Fil / <br />~ Vi¢AI,Ey / <br />~ <br />/~'Ci <br />3. Permitted acreage (new or exiatias site): ~~5~.~ permitted acres <br /> 3.1 Change in acreage (+ or -) acres <br /> Total Acreage in Permit Area acres <br />4. Fees: <br /> 4.1 New Application 5875.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)) 5575.00 application fee <br /> 4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: t5{~N~ (OIPAV~I, <br /> 5.'1 Incidental commoditie(s) to be mined: 1. _ lbs/Tons/vr <br /> 2. / 1bs/Tons/vr 3. _ / 1bs/Tons/yr <br /> 4. / 1bs/Tons/vr 5. / lbs/Tons/yr <br /> 5. 2 Anticipated end use of primary commoditie (s ) to be mined: ~OAO RIkSE,L.~TjCY(i1'/ON <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />