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e~i SSSf /Y1 -- ~ dc~ -o~q / ~'o: ~~~ CONSTRUCTION MATERIALS 1/ LIMITED IMPACT (110) OPERATION RECLAMATION PERMIT APPLICATION FORM CHECK ONE: There is a File Number Already Assigned to this Operation RECEfVED APR i 8 2006 Division of Minerals antl Geology RECEi~9ED / JUN 14 2006 Division of Minerals and Geology Permit # M -_ _ _ (Please reference the file number currently assigned to this operation) X New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Conversion Application (Rule 1.1 I) Permit # M - _ (provide for Amendments and Conversions of existing permits) The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections ofExhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) [he application fee. When you submit your application, be sure to include one (1) co~lete siened and notarized ORIGINAL and one (1) copy ofthe completed application form, two (2) copies ofExhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2"X I1" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, ALL information described below. 1. Apolicapt/operator or company name (name to be used on permitl:Chevron Shale Oil Company, a division of Chevron U.S.A. Inc 1.1 Type of organization (corporation, partnership, etc.): Corporation 2. Operation name (pit mine or site name): 3. Permitted acreage (new or existing site): 3.1 Change in acreage (+) 3.2 Total Acreage in Permit Area 4. Fees: North Cleaz Creek Construction Materials Mine a.~ permitted acres acres .~~ acres 4.1 New Application: 1 094.00 application fee Amendment Fee (C.R.S. 34-32.5-125(II)): 719.00 application fee 4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) 5. Primary commoditie(s) to be mined: ~ ~'°pp~ sGt~S {ermea~ of toLLuViWyt Ginp( 0.UcWlUM den'ved fYom hha 5.1 Incidental commoditie(s) to be mined: L 0 / lbs/Tons/yr 2. / lbs/Tons/vr 3. / Ibs/Tons/vr (green 4. / lbs/Tons/vr 5. / ]bs/Tons/vr RivH'cfhalC 5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Materials ~mlXflOri Anticipated end use of incidental commoditie(s) to be mined: