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~ ~ ~ ~ ~ ~ III IIIIIIIIIIIII III ~ { ~h; ~~~~CE~~ED LIMITED IMPACT OPERATION (1 10(2) ) ~rR ~ ~ X991 RECLAMATION PERMIT ~"~~~E~, ~~~ APPLICATION FORM Re~Ia"IaU~n Di sips The application fora Limited Impact Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A-J; and, (3) the application fee. When you submit your application, be sure to include two (2) signed originals of the application form, two (2) copies of Exhibits A-J, and a c~ltecc'rfor the application fee described under (3) below. To expedite processing, please provide the information in the format and order described in this form. ~-_ 1, 3 ~---- 9 9-J 9'i 93 3 9 GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 7 ..3 3 J ~J ~ 3 1. Applicant/operator ndRle: Pridemore ('on.~;t rnrtinn Tnr 1.1 Type of organization (corporation, partnership, etc.): Corporation 2. Operation name (pit, mine or site name): Lota Rock Pit 2.1 I.R.S. Tax ID No. or Social Sea rity No.: 3. Application fee for permitted acreage* 8 permitted acres (525..00 + 10/acre}* Note permitted acreage and application fee and ~ oe attach a check for this amount when you file. ~.-gp application fee 4. Substance(s) to be mined (e.g., gravel/gold/borrow): Gravel s cola 5. Name of owner of surface of affected land: a. z. aobeso^ 6. Name of owner of subsurface rights of affected land: R.L. Robeson 7. Type of mining operation: 7~ Surface _ Underground _ In-situ 8. Location information. The center of the area where the majority of mining will occur lies in: COUNTY: Park PRINCIPAL MERIDIAN (check one): 6th (Colorado) 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T ~ North ~~outlt R,4NGF_ (write number and check direction): R 1Z East ~ West SECTION (Write number): S ~~,,33__ QUARTER SECTION (check one): CIE g NW SE SW GEl~EpA6/D~SCRIP7 ONTION (check ane): _ NE _ NW _ SE _ SW (rriiles and diraction 2 miles north west of Fa_irplav_ C'p frphl Mi~r~It town end approximate elevation) Approximate elegy. ~n 'Inn Fr * A fraction of an acre must be counted as one acre for fee calalation. If the operator is a unit of state or county government, an application fee is not required.