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<br />STATE <br />^IVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />151.1 Sherman $t., Room ? 15 <br />Denver, Gilurarlo N0203 <br />Phune: (307) d66~35hi <br />FAX~1.107) a32-8106 <br /> <br />SEP 2 ~ 2001 <br />division of Minerals and GeolollY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />DIVISION OF <br />MINEfiALS <br />GEOLOGY <br />RECLAMATION <br />MININ G•SAF ETY <br />Bill Owens <br />Governor <br />M / /f oo I ~ ~ o o Cre(; E Walther <br />L Eaecmive D~reclor <br />CHECK ONE: X New A licazion Rule 1.4.5 Amendment A lication Rule 1.10~1 chael a. Long <br />PP ( ) PP ( Dwision Director <br />Conversion Application (Rule 1.11) <br />Permit q M - _ (provide for Amendments and Conversions of existing permiu) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (l) the application form; <br />(2) Exhibiu A-S, Addendum 1, any sections ofExhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete signed and notarized IVORY ORIGUVAL and four (4) copies of the completed Ivory <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 application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 I/2" X 11" or 8 1/2" X 14" 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, itt the space provided, ALL information requested below. <br />1. Aonlicsot/ooerator or comoaov name (name to be used on permit): UNITED COMPANIES OF MESA COUNTY, INC <br />I.1 Type oforganization (corporation, partnership, etc.): CORPORAT <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Operation Dame (nit- mine or site name): BLM PIT <br />3. Permitted acreaee foew or existine site): 35.6 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit area 35.6 acres <br />4. Fees <br />4.1 New Application 2,344.00 -y};8}5-gp application fee <br />4.2 New Quarry Application 2 , 906.00 -543-25-9@ quarty application <br />4.3 Milling Application (Non-DMO) -S3:-I&~9~ milling application <br />4.4 Amendment Fee 1, 938.00 ~- amendment fee <br />4.5 Conversion to 1 l2 operation (set by statute) 2 , 344.00 °~~ conversion fee <br />5. Primary commoditie(s) to be mined: SDG <br />5.1 Incidental commoditie(s) to be mined: I. Ibs/fons/vr 2. / Ibsrfons/vr <br />3. / Ibs/fons/vr 4. / Ibs/I'ons/vr 5. / Ibs/i'ons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: CONSTRUCTION AGGREGATES <br />5.3 Anticipated end use of incidental commoditie(s) [o be mined: CONSTRUCTION STRUCTURAL FILL <br />