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TATE OF COLOI~DO <br />DIVISION OF MINERALS AND GEOLOGY RECEIVED <br />Department of rYatura! Resources <br />1313 Sherman St:, Room 2ri ~ ~ MAR ~$ 2004 D I v t s l O N c <br />Denver, Colorado 802D3 - <br />Phone: (303) 866.3567 IN I I~l E RA I. <br />Fax: c3D3) 832-aro6 jh~ision ~f Minerals and Geology &- <br />GEOLOG <br />LINIITED IMPACT OPERATION (110(2)) R E c L A M a T l o <br />MINING•SAFE~ <br />RED •AMATTON PERMIT <br />APPISCATION FORM wu Owe". <br />Governor - <br />Greg E. Wa(cher <br />CFIECK ONE: New Application (Kale 1.4) p(~q Comersian Application (Rule 1-11) Executive Dtrector <br />. Michael B. Long <br />Division Direttar <br />Permit # M-~- (provide for conversions of existing permits) . <br />The application for a Limited Impact Designated Mining Operation Acclamation Permit contains three major parts: (I) the <br />application form; (Z) Exhibits A-J, any required sections of Evclnbit S and Geotechnical Stability Faclubit, as required by the OSce, <br />and outlined in Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure to inclu <br />6.4.19 Exhrbit S and 6.5 (Geotechnical Stabiiiiy rs"~mr), as regained, and a check far the application fee descn'be<i under (4) Seio~ <br />Exhribits should not be 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 expedite <br />ptocesgng; please provide the infe~ation in the format and order descnbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, as information descn7red below <br />.T•sart, .~rtrrr N~,RDan~" <br />1. AnnFicant/oaerator or comnanv name (name to be used on the ner~t): T t, s n~ a r n. z n ! x.. nn i n i A.f a cLy in <br />1.1 Type e6OigamzahOII (corporahOn, paIIBeZSlllp, etC.): P~/ ~/ 9 i R An !N II i4 r--Q ~/~ k 4-T O /2 A n, q Y ~ M <br />12 LR.S. Tau ID No.: N ~A <br />2. Operation name (nit, mine or site name): T u r .w o u !v r ra r n, nn ! nr l /v H c c A / M <br />3. Permitted acreage (new or ezislim¢ site): <br />4. Fees• <br />4.1 New Applicahion <br />4,2 ComretsionFee (from 110dto 110(2), (Itnie 1.112(2)) <br />5. Primary eommoditie(sl to be mined: G 0 1. a _ <br />LQ f t Tea qn.r an.c /c1 c~rE permitted acres <br />$875.00 application fee <br />N~A $875,txi comrersionfee <br />6. Name of ownerto the surface of a$ecbed land: T 0 S R pN c a n Tr S M A R ?~ 8 N <br />7. Name of owner to Ure subsurface rights of afl'ected land: J D S /i ly /•] (~ K T 1 s )~ A R X~ d N <br />8. Tvoe of IDining operation: ~ SuiEsce Underground III-situ <br />