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TATE OF COLORADO <br />DIVISION OF MINERALS AND <br />Department of Natural Resources <br />1373 Sherman 6t., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303)832-8706 <br />SCA <br />CONSTRUCTION MATERIALS <br />RECEIVE® ~~ <br />NOV042002 DIVISION OF <br />MINERALS <br />Division of Minerals and Ceo1o ~ <br />9 GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />Bill Owens <br />Governor <br />Greg E. Walther <br />CI~CK ONE: There is a File Number Already Assigned to this Operation Execurive Dfreaor <br />Ronald W. Cattany <br />Permit # M I I _ (Please reference the file number cuFrently assigned to this operation) Acting Dlvlson D{reaor <br />x New Application (Rule 1.4.5} Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -~~~1~~-_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When yon submit your application, be sure to <br />include one (1) complete siared and notarized IVORY ORIGINAL and one (1) copy of the completed No application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendtm ], and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described und.°r (4) below. Exhibitsshould NOT be bound or in.a 3-ring binder, maps shouted be folded to 8 1/2" X 11" or <br />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 clearlyrsn the apace provsded, ALL hnformation described below. <br />1. AnolicanUoperator or company name (name to be used on Dermitl: OLDC{151hE cS W 61Pt7t1P, ~~' G, DBIF U tl CtE~ <br /> 1.1 T eofor anization ratio <br />yp g (cargo n, partnership, etc.): f3~R~fJR~iTi9J~ eOM.PAr~tEs <br />D~ nlfsA <br /> 1.2 I.RS. Tax ID No. or Social Security Number: 2.: $t} - o~ 4 9 53 6 <br />eou NTY <br />2. Operation name (nit, mine or site name): ~Q R6A11 ~ l'f <br />3. Permitted acreage (new or eahsting site): ~ 4•ZS permitted acres <br /> 3.1 Change in acreage (+) acres <br /> 3.2 Total Acreage in Permit Area ~ ~. ~ acres <br />4. Fees: <br /> 4.1 New Application: $1.094.00 application fee <br /> Amendment Fee(C.RS.34-32.5-725(II)): $7]9.00 application fee <br /> 4.2 Conversion Fee (from 110d to 110 87 .00 conv <br />ersion fee (Rule 1.11.2(2)) <br />5. g <br />Primary mmmodhthe(s) to be mined: afl7t/Q f'I-1d1) ~Q+Q~~` <br /> 5.1 Incidental commoditie(s)tobemined: 1. I lbs/fons/vr 2. / lbsffonsJXr 3. / 1bsJTonslvr <br /> 4. / Ibs/Tonsfvr 5. ! <br />Ib <br />slTons/vr <br /> __ <br />AA_- _- <br />5.2 Anticipated end use of primary commoditie(s) to be mined: lC619P <br /> Anticipated end use of incidental commoditie(s) to be mined: <br />