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<br />,~zeei~-f~ 7'f 7y <br />FILE COPY ~=C~,TE OF.,~OLORADO <br />DIVISION OF MINERALS AND GE~r~j a7NM/r/rIIrM --` r cu <br />Department o(Namral Resources <br />1313 Sherman SL, Room 21 i ,/APR 1 2 ?~t~2 <br />Denver, Colorado 80203 D I V I S I O N O P <br />Phone: (3031866-3567 CONSTRUCTION MATERIALS Division at Minerals and Geology MIN & RA L J <br />Fnx: (3031 a32-8t o6 REGULAR (112) OPERATION <br />GEOLOGY <br />RECLAMATION PERMIT APPLICATION FORM R E C L A M A T I O M <br />MINING•SAFETY <br />Bill Owens <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Greg E. WaI<her <br />Permit # M -~~ D~ ~ `/ (Please reference the file number currently assigned [o this operation) Executive Director <br />X New Appbcation (Rule 1.4.x) <br />Michael 8. long <br />Amendment Application (Rule I.10) Division Director <br />Conversion Application (Rule 1.11) <br />Permit # M -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application foe. When you subaut your <br />application, be sure to include one (1) complete si¢ned and notarized IVORY ORIGINAL and four (4) espies of the wmple[ed No <br />application form, five (5) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the apphca[ion fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to <br />8 1/2" X I1" or 8 112" X ]4" size. To expedite processing, please provide the information in the 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. A~n GcanUonerator or romoanv name (Dame to be used on permit): <br />4trestern Equipment & Truck Inc. <br />1.1 Type of organization (corporation,parmership,etc.): Corporation <br />1.2 LRS. Tax LD. No. or Social Security Number: <br /> Two Rivers Rock <br />2. Operation name (nit, mine or site name): <br /> 48.5 <br />3. Permitted acrea¢e (new or eaistin¢ site): permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit azea 44 8~5 acres <br />4. Fees: <br />4.1 New Application $2 344 00 application fee <br />4.2 New Qitatrv Apphcation $2 906.00 quarry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Primary commoditie(s) to be mined: Sand & Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. / Ibs/Cons/vr 2. / ]bs/Tons/vr 3. / lbsllons/vr <br /> 4. / Ibs/1'ons/vr 5. / lbs/I onsivr <br />~.2 Anticipated end use of primary commoditie(s)tobemined: structural fill, screene d aC(greC(ate5 <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />