PERMFILE57631

• Permit No: M2004053
• IBM Index Class Name: Permit File
• Doc Date: 7/21/2004
• Doc Name: Application
• From: Riveras Excavation
• To: DMG
• Media Type: D
• Archive: No

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STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
13135herman St, Room 275 F`'~'"°G1~ED COLORADO
Denver, Colorado 80203 DIVISION O F
Phone: [phone] CONSTRUCTION MATERIALS JUL 2.2004 I N &RA L s
FAX: (303) 832A706 G E O L O G Y
LIII~IITED IMPACT (110) OPERATION ~
Division u; ly.nwrals&Gesls CLANATION•NINING
SA FETY •SCtENCE
RECLAMATION PERMIT APPLICATION FORM
gal ovens
% Governor
~ Greg E. Wakher
CHECK ONE: There is a File Number Already Assigned to this Operation Executive Director
Pemmt # M -_ _ _ (Please reference the file number currently assigned to this operation) Ronald w. Catlany
Division Director
/New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Natural Resource Trustee
Conversion Application (Rule 1.11)
Permit # M -_ -_ (provide for Amendments and Conversions of existing permits)
The application foraConstructionMaterialsLimitedlmpact(I10)OperationReclamationPemvtc~tainsthreemajorparts: (1)theapplication
form; (2) Exhibits A-J, Exhibit L, Addendum 1, a~ sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and
outlined in Ruies 6. I, 6.2, 6.3, 6.5, and 2.6.2(1)(6); and (3) the application fee. When you submit your application, be sure to include one
(1) comolete sited and notarizefl IVORY ORIGINAL and one (1) copy of the completed I~ application form, two (2) copies of Exhibits
A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee
described under (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to 8112" X 11" or 81/2" X 14" size.
To expedite processing, please provide the information in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the apace provided, ALL information described below,
1. AopGcant/oaerator or rnmoanv name (name to be need on cermitl: ~I F U7 /O .tea E ~~ Uf k' ~ .
1. ] Type of organization (corporation, Partnership, etc.): SO ~P=~/~ /?/) ~ /2 / F.><h /L.
] .2 1.2 I.R.S. Tax ID No. or Social Security Number: . ~i ,~ S - 9 ~ - Q{ ] 0
2. Ope ration name (oit" mine or site same): ~/ !/c f2 H S L~1G(t A// f7 j'/ OA/ G G A U ~ ~ j~ f.
3. Permftted acreage (new or existing site): ~[L permitted acres
3.1 Change in acreage (t) acres
3.2 Total Acreage in Permit Area ~ acres
A. Fees:
4. ] New Application: $ I ,094.00 application fee
Amendment Fee(C.R.S.34-32.5-125(II)): 719.00 application fee
4.2 Conversion Fee (from I lOd to 110 $
875.00 conversion fee (R ule 1.11.2(2))
5. Pri n
mary commoditie(s) to be mined: (9 tGU
5.1 Incidental commoditie(s) to be mined: 1. /Clams lbs oll~n~s yr 2. / lbs/Tons/vr 3. / lbs/Tons/vr
4. / lbs/Tons/vr 5. / lbslfons/vr
5.2 Anticipated end nee of primary commoditie(s) to be mined: Ul/1 5 t ~r G c fi/i.ri '~' {~r, A n _7 ci ~ F~{i
Anticipated end use of incidental commoditie(s) to be mined: /l/o iy f
()Ffice of Office of Colorado
Mined Land Reclamation Active and Inactive Mines Geological Survey