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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 2i 5 <br />Denver, Colorado 80203 D[ V t s t O N O F <br />Phone; (303) 866-3567 ~~~l9~?.`~ MINERAL S <br />FAX: (303) 832-8106 CONSTRIICTION MATERIAIS // ~ ~ <br />//~R1 (fin GEOLOGY <br />„/~I.IlKITED IIDIPACT (110} OPERATION ~ Zl;t; y R E C L A M A T I O N <br />MINING•s AFETY <br />RECLAl1rIATION PERMIT APPLICATION FOl~tsron o) Mineral; L,,. <br />8711 Owens <br />Governor <br />Greg E. Walther <br />CHECK ONE: There is a File Namlxr Already Assigned to this Operation &ecutire D;recto. <br />Ronald W. Caaam/ <br />Permit # M -~i „~- djd(Please reference the file number currently assigned to this operation) Ong Division Director <br />New Application (Role 1.4.s) Amendment Application (Kale 1.10) <br />Conversion AppGcatioa (Role 1.11) <br />Permit # ~_-_- _ (provide foz Amendments and Converaiona of exisOmg permits) <br />The application for a Constnuuion Materials Limited Impact (110) Operation Reclamati~ Permit contains three major parts: (1) the <br />application font; (2) Exhibits A J, Exhibit 1., Addetidrtm 1, any sections ofFxhrbit 6.s and t reotechnical Stability Exhibit, as regaued by the <br />Office, and outlined is Rules 6.1, 6.2, 6.3, 6.s, and 1.6.2(lxb); and (3) the application fee. When yon submit your application, be sure to <br />include one (1) c~p)~gned and natarbed IVORY ORIGINAL and erne (1) copy of the completed ~' -Y application fo>m, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.s (Geoteclutical Stability Exhibit), as required, and a check for the <br />application fee descnbed under (4) below. F.xhtbits should NOT be bonad or is a 3-ring binder; maps should be folded to 8 1/2" X 11" or <br />8 1!2" X 14" size. To expedite pmcessing, please provide the i>¢ormalion m the format and order deacnbed is this form. <br />GENIIlAL OPERATION INFORMATION <br />or print clearly, in the space provided, ALL intotmat[on described bebw. <br />1. ADOlicantlooerator or rnmoanvname (name to be used on cermit): 1 ~ c~"$~~ e-- rJ~-^ V <br />1.1 Type of organization `~ partaeralup, etc.>: rs u~Sl r h0.~~pj ~ CO 2~ T/mr <br />1.2 I.RS. ax ID No or Social Security Number: 2.: ~' a` ~ ~ SS a a t,p <br />2. Operation name (alt. mine or site camel: f ~~ I''e S ~r,e ~ j~R RV <br />3. Permitted acreage (new or emistm¢ alter: ~ permitted acres <br />3.1 Change in acreage (+) <br />3.2 Total Acreage in Permit Area <br />4. Fees: <br />D a~ <br />_.LL acres <br />4.1 New Application: 51.094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-I25(II)): 5719.00 application fee <br />4.2 Conversion Fee (from 110d to 110 5876.00 ccmvetsian fee (Rule 1.11.2(2)) <br />s. Primary commodttiefsl to ne mined: ~ ~ `f'2_. ~ D ~"'/G. ~h' ,`~~. <br />s.l Incidental co>mnoditie(s) to be mined: 1. 30 (rX) 'l~a/fan_s~/ r <br />4. ,30jJ(~ 1bslTons/vr <br />5.2 Anticipated end use ofpgmiary commoairic(a) ro be mined: <br />Z. ~dA'O ibsffons/~r 3. ~iOlll~ Ibsrfons/vr <br />5. ~ ~~ Ibs/fonslyr <br />~v~1 btN~_ ti,~t-e,tLia.Q <br />Anticipated end use of incidental commoditie(s) to be mined: <br />