PERMFILE57265

• Permit No: M2000040
• IBM Index Class Name: Permit File
• Doc Date: 3/14/2000
• Doc Name: MEDICINE BOW ROUTT NATIONAL FOREST USDA FOREST SERVICE STATE LINE RANCH PIT FN M-2000-040 RECEIPT
• From: DMG
• To: USDA FOREST SERVICE PARKS RANGER DISTRICT
• Media Type: D
• Archive: No

DIVISION OF MINERALS AND GEOLpGN
Depanmem ro Natural Resources
1773 Sherman SI., Room Z15
Dem~er. Colorado 80203
Phone: [phone]'
FA1: UD31832-81 n6
CONSTRUCTION MATERIALS
~ ~~
C~OLOIZ~~O
MAR

LIMITED IMPACT (110) OPERAfr. -; ~ ~400
,.,,,Krdp g Geo
RECLAMATION PERMIT APPLICATION FORM /08Y
DIVISION Of
MINERALS
6c
GEOLOGY
RECtAM ATION'
MINING•$AF ETY
Bat oven,
crnrrnor
GregE Walcha
Fvecmrve Dvenor
Michael B. long
Divinon Director
CHECK ONE: ~_ New Application (Rule 1.4)
Conversion Application (Rule 1.11)
Am~~(e77}ny''jjdyym~~ent Application (C.RS. 34-32.5-110)
Permit q Ma'UW ~ ~ (provide for Amendments and Conversions of existing permits)
The appGca>ion for a Cortslruction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the application form;
(2) Exlubils A-], Ex}u-bit L, Addendum I, any sections ofExluba 65 and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules
6.1, 6.2, 6.3, 6.5, and ].6.2(1)(6); and (3) the application fce. When you submit your application, be sure to include one (1) complete si¢ned and
norarvcd IVORY OR1GQdAL and one (I) copy ofthe completed ivo application form, two (2) espies of Exhibiu A-], Exhibit L, Addendum 1, and
appropriate sections of 6S (Geotechnical Stability Exhibit), as required, and a check for the application fce described under (4) below. Exhibits should
NOT be bound or hl a 3-rutg bhtder, maps should be folded to 8 12" X 11" or 81R" X 14" siu. To expedite processing, please provide the information
in the formaz and order described N this form.
GENERAL OPERATION INFORMATION
Type or print clntty, in the space provided, ALL information described below.
1. Aouliunt/opentor or eomoaov oamelname to be u~ on ttermitl: Medicine Betil - RDUf~ Noti nnn l Fores t
1.1 Type of organ'vation (corporation, parmersbip, etc.): F dP ra I Ape n r v f U . 5. D. A Forac { Sr rvi c e
1.2 I.R.S. Tax ID No. or Social Security Number: N /A
2. Operation name (nit, mine or site name): ${o j~ Line Flan eh Pi t
3. Permitted acreage (new or existin¢ site): permitted acres
3.1 Change in acreage (+) acres
Total Acreage in Permit Area acres
4. Fees:
4.1 New Application: 5875.00 application fee
Amendment Fee (C.R.S. 34-32.5-125(11)): $575.00 application fee
43 Conversion Fee (from 11 Od to 110 875.OD conversion fee (Rule 1.11:2(2))
5. Primary commoditie(s) to be mined: Pi } ~I I n ~ ~a}
5.1 Incidental commoditie(s) to be mined: 1. / Ibsrfons/vr 2. / IbslTons/vr 3. / Ibs/fonslvr
4. / Ibslfons/vr 5. / Ibs/fon r r
5:1 Anticipated end use of primary commoditie(s) to be mined:
5.3 Anticipated end use of incidental commoditie(s) to be mined: 4 q ~ DOD G.l bi G VarcjS
REC~~~E p