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III IIIIIIIIIIIIIIII <br /> TATE OF COLORADO <br /> DIVISION MINERALS AND GEOLOGY <br /> n of <br /> Depamenf of Natural Resources <br /> J 31 3 Sherman 81., Room 215 <br /> Denver,Colorado 80203 <br /> Phone (303)866.3567 FAX:(303)832-8106 /CVMAR i 9 1399 <br /> DEPARTMENT OF <br /> CONSTRUCTION MATERIALS NATURAL <br /> Division of Minerals Geology RESOURCES <br /> LIMITED IMPACT (110) OPERATION <br /> Rov Romer <br /> RECLAMATION PERMIT APPLICATION FORM Governor <br /> James 5.Lmhhead <br /> F.ecu!ive Dvecror <br /> brichael B.Long <br /> CHECK ONE: '� New Application (Rule 1.4) Conversion Application (Rule 1.11) Division Director <br /> Amendment Ap(p�l(ilcati (C.R.S. 34-32.5-110) <br /> Permit # VII - I "I -�-_ (provide for Amendments and Conversions of <br /> existing permits) <br /> The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit <br /> contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, <br /> any sections of Exhibit 6.5 ,and Geotechnical Stability Exhibit, as required by the Office, and <br /> outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2 (1) (b) ; and (3) the application fee. When you <br /> submit your application, be sure to include one (1) complete signed and notarized IVORY ORIGINAL <br /> and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A-J, <br /> Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit) , as <br /> required, and a check for the application fee described under (4) below. Exhibits should NOT be <br /> bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 6 1/2" X 14" size. To <br /> expedite processing, please provide the information in the format and order described in this <br /> form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, ALL information described below. <br /> 1. Applicant/operator or company name (name to be used on permit) : <br /> "Ff�MoN'[ L.puh"-q OF �eMM1SSrO�d E.CsS <br /> 1.1 Type of organization (corporation, partnership, etc. ) : GroY'T k'C-►'4L`1 <br /> 1.2 I.R.S. Tax ID No. or Social Security Number: - .,o '7p <br /> 2. Operation name (nit, mine or site name) . NbWazD ' s>%-r 2- <br /> 3. Permitted acreage (new or existing site) : permitted acres <br /> 3.1 Change in acreage (+) acres <br /> Total Acreage in Permit Area 9 acres <br /> 4 . Fees: <br /> 4.1 New Application $675.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125 (II) ) $575.00 application fee <br /> 4.2 Conversion Fee (from 110d to 110 87$ 5.00 conversion fee (Rule 1.11.2 (2) ) <br /> 5. Primary commodities) to be mined: <br /> PAD Malts CQrv,:l� <br /> 5. 1 Incidental commoditie (s) to be mined: 1 . 300o p_ -1- s/Tors/vr <br /> 2. / lbs/Tons/yr 3. / lbs/Tons/vr <br /> 4 . / lbs/Tons/vr 5. / lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: Reav NX#'TiS <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: ^'�A <br />