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IVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />M ~ ap6 ~ <br />1313 Sherman St, Room 215 C ~ L O RA D O <br />Denver, Colorado 80203 D I v t 5[ o N o f <br />Phone: (303) 86b3567 CONSTRUCTION IyjATA.RiAi C M I N FORA L S <br />FAX: (303) 832-8106 REGIILAR (112) OPEBATION ~' ~ A " ' "' o~~ G E O L O G Y <br />RECLAMATION PERMIT APPLICATION FO REGLANATION•N IN iNG <br />SAFETT•ECIENCE <br />~ir t ~ ~'VO <br />- a o O ~ - p a- jr arv(aror, ~. ~ aia own: <br />CHECK ONE: There h a Fik Ntmrher Airead~ Aesigned to this Operation Mrnrn`, `''~~ ~ale~ on' ~~~ <br />Permit # ~vf -_ _ _ (Please reference the Sle number currently assigned to this operation) Execwre Direcor <br />X New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10} ~~ ~^'' ca"a"y <br />Division Director <br />Conversion Application (Rule 1.11) Nature( Resource Tnntee <br />Permit # ~_-_ _ (provide for Amendmeasb and Conversions of adsdng perrtlits) <br />The application far a Conahtutien Materials Regular 112 Operation Reclamation Permit txmtaias three major paAs: (1) the application form; <br />(2) Erdubits A-S, Addendtmz I, a~ sections of Exhibit 6.5 (Geotechnical Stability Exhtl>it; and (3) the application fee. Whenyou submitywr <br />application, be sun to include one (1) c~lete sinned and notarized ORIGINAL and one (1) E>opyof the completed applicationfarm,tav (2) <br />copies ofExlubits A-S, Addeodtmi 1, appropriate sections of 6.5 (t.~eotacLnica] Stability Exhibit, and a check for the application fce desatbed <br />under Section(4)below.Exlubitsshould TAO'jbebotmdorina3-ringbinder;mapsshouldbefoldedto8l/L"X11"or81/2"X14"siae.To <br />u P Please provide the information in the format and order described in this farm. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace Provided, Imo. information regtunted below. <br />1. Aeplkant/ocersrtor or Ewmoanv name (name to be treed on Hermit): Delta County <br />1.1 <br />Type of organization (caporatian, partnership, etc.): Government <br />1.2 I.R.S. Tax I.D. No. or Social Security Ntmmber <br />2. O~eratfonname(Hit.mineorsiteHame): Whiting Pit <br />3. Permitted acreage (Hew or eriatiHe site): <br />3.1 Chaoge in acreage (+) <br />3.2 Total acreage in Permit area <br />4. ~: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Cenverson to 112 operation (set by statute) <br />115.0 permitted sues <br />52344.00 application fee <br />52.906.00 tplarry appheati~ <br />$1.938.00 ameodmentfee <br />52.344.00 canvetsionfee <br />5. Prhnarv commoditie(s) to 6e mined: Gravel Sand <br />5.1 Incidental commoditie(s) to be mined: 1. - lbsffotlslvr <br />3. / ms/I'ans/ar 4. / lbs/Tons/vr <br />2. / ms/fons/vr <br />5. _ / lbs/follsPor <br />5.2 Anicipated end use of primary oommodite(s) to be mined: Road construction aggreqate <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined Land Reclamation Attive and Inactive Mines Geological Survey <br />