PERMFILE48710

• Permit No: M2005067
• IBM Index Class Name: Permit File
• Doc Date: 2/28/2006
• Doc Name: 110c Permit
• From: Carrizo Stone LLC
• To: DMG
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY

Department of Natural Resources ,
R E C E B V E D
t3135herman St., Room 2r5 COLORADO
Denver, Goiorado acsD3 ~ ~ FEB 2 8 2006 M i N & NA L s
Phone: [phone]
FAX: [phone] G E O L O G Y
OivisionofMineralsandGealogy 0.ECLANATION•NININf:
EARETY•E(:IEN CE
CONSTRUCTION MATERIALS
LIIIIITED IMPACT (110) OPERATION Bill Owens
Governor
RECLAMATION PERMIT APPLICATION FORM Russell George
Enecutive Director
Ronald W. fattany
CHECK ONE: There is a Ft7e Number Already Assigned to this Operation Division Director

~~ Natural Resource Trustee
Permit # Zvi
Ole2_ (Please reference the &le nttmber cmTently assigned to tlris operation)
New Application (Rtrle 1.4.5) Amendment Application (Rule 1.10)
Converaoon Application (Rule 1.11)
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, a~ sections of Exbibit 6.5 and Geotechnical StabilityExbrbit, as requiredbythe
Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(I)(b); and (3) the application fee. When you submit yow application, be sure to
include one (1) co, mplete signed and notmized ORIGINAL and one (1) copy ofthe completed application form, two (2) copies ofExtubits
A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotec}mical Stability Exhibit), as required, and a check for the application
fee described under (4) below. Exhibits should NOT be bound or in a 3-ringbinder, maps should be folded to 8 I /2" X 11 " cr 81/2° X 14"
size. To expedite processing, please provide the information in the formal and order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly, io the apace provided, ALL information described below.
1. Aaulicantlocerator or comoanv name (name to be used on~ermitl:
1.1 Type of organization (corporation, partnerslrip, etc.): ~- t ~ t~
2. 9ceration name (oM. tn~e or site Dame]:
3. Permitted actvaQe (new or eaiatin¢ ake):
3. I Change in acreage (+)
3.2 Total Acreage in Permit Area
4. ~:
4.1 New Application:
Amendment Fee (C.RS. 34-32.5-125(!1)):
Conversion Fee (from 110d to 110 8~ 75.00 conversion fee (Rule 1.11.2(2))
e
Q . ~ permitted acres
acres
acres
1 094 00 application fee
00 a lication fee
5. Primary commoditie(s) to be mined: ~'n d S'~' OY~ ~,
5.1 Incidental commoditie(s) to be mined: 1. N ~/ lbs/Tons/yr 2. N~ lbs/I'ons/Xr 3. ~~/ Ibsffons/vr
4. N~/ Ibs/Tons/vr S.rI~ / lbs/fons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: C O~ S~ f U L~ • .~ !~ S} 0 n e-
Anticipated end use of incidental commoditie(s) to be mined:
~r ~,
Office of Office of Colorado
Mined Land Reclamation Active and Inactive Mines Geological Survey