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pert=t~IFp <br />AUG 2 7 2007 STATE OF COLORADO <br />Division of Reclamation, <br />Imng an <br />DIVISION DF RECLAMATION, MININQAND SAFETY <br />Department of Natural Resources ~ ~ n Il ~) ) <br />7373 Sherman St., Room 2~ ~~` ~ ~~ ~ ~{/ U ~" " O y <br />Denver, Colorado 80203' `~ei C O L O R A D O <br />DIVISION O r <br />PFione: t303t 866 ~i~ ~ RECLAMATION <br />FrUC; (303) 832~8[~ ~^oo~ MINING <br />1 L SAFETY <br />PvG `e`dpK~~ ~~ CONSTRUCTION MATERIALS <br />rUpgo~26o~s e~ ~ LIb1ITEll IMPACT (I IO) OPERATION 811 Amens <br />Governor <br />~,,~._lOP O and <br />~jN'`' `pS~ RECLAMATION PER1171T APPLICATION FORM Russell eeorge <br />Executive Director <br />Ronald w. Cottony <br />CHECK ONE: There is a File Number Already Assigned to this Operation - Division Dfreaor <br />Natural Resourrc Trustee <br />Pemilt # M -_ ~ _ (Please reference the file number currently assigned [o tbis operation) <br />r~New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rtile 1.11) <br />Permit # M - ~_ ` (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (t 10) Operation Reclan7ation Permit contains three major parts: (Q the <br />application form; (2) Exhibits A-I, F,xhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and oudined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(()(6); and (3) [he application fee. When you submit your application, be <br />sure [o include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendtun 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described tinder (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to S 1 /2" X <br />11" or 8 1/2" X 14" size. To expedite processing, please provide the information in [he format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Apolicant/ooerator or comoanv name (name to be used on cermitl: A//Ft//l...lo ~7r? f/C ~P~[/L'r P~ L ~- <br />1.1 Type of organization (corporation, partnership, etc.): ~1 <br />2. Operation name foil. mine or site namel: /9l2 ~n29 ~o/t ,Ut rZ / ~ f ~ <br />3. Permitted acreage (new or existing sitel: ~ 2 permitted acres <br />3.1 Change in acreage (+) ~~ acres <br />3.2 Total Acreage in Permit Area ;2 `f acres <br />4. Fees: <br />4. I New Application: $1094_00 application fee <br />Amendment Fee (<;.R.S. 34-32.5-125(II)): X719.00 application fee <br />4.2 Conversion Fee (from 110d to 110.75 _00 conversion fee (Rule 1.1 L2(2)) <br />5. Prtmarv commodide(sl to be mined: ,L°~ So / ~. _ <br />5.1 Incidental conmtodiGe(s) to be mined: L/~DAO Nd'I'ous/vr <br />4. ~~ Ibs/'1'ons/yr <br />51 Anticipated end use of primary commoditie(s) to be mined: <br />Anticipated end use of vrcidental commoditie(s) to be mined: <br />2. ~~ dkall'ons/xr 3. ~~d ~s/['ons/vr <br />5. ~ OFD llaPfons/vr <br />~~/J,l]~/~ .~ <br />/// <br />OHim of <br />Mined Cand Reclamation <br />OHire of <br />Att(ve and Inactive Mines <br />