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TATE OF COLOlZADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Na[ural Resources ~~~~ ~®~ ~~.,_._ ., __r~ <br />1313 Sherman St., Room 215 ,~j ~`y)/q~ /y~~/}(~~/^ J <br />Phones( 03)666-35673 ,~~,/~ :~d P.f~~"~~!s'~~ <br />FAX; (303) 832-8106 MAY 0 3 2004 / <br />Division at Minu:als & Geology <br />CONSTRUCTION MATERIALS <br />11EGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM / <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING•SAEETY <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: There is a FDe Nnmber Already Assigned to this Operation <br />Ronald W. Cottony <br />Permit # M -2o O I~-~ ~ (Please reference the file nomber currently assigned [o this operation) Acting Division Director <br />X New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule ].1 I) <br />Permit # M -^ -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Constinction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhtbiu A-S, Addendum 1, say sections of Exhibit 6.5 (Geotec]ntical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to i~lnde one (1) complete siened and notarized IVORY ORIGINAL and one (1) copy of the completed I ~ application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotecllnical Stability Exhibit, and a check for the application <br />fee described ender Section (4) below. Exhibits sheuld NOT be bound or in a 3-ring binder; maps should be folded to 812" X I l" or 8 1/2" <br />X 14" size. To expedite processing, please provide the information in the format and order deserrbed in this form. <br />GENERAI.OPERATION INFORMATION <br />Type or print clearly, in the space provided, AL,L information requested below. <br />t. AonlicanUoceratororcomoanvaame(nametobeosedoncermk): Aggregate Industries - t~JCR, Inc. <br />1.1 Type of organization (corporation, partnership, etc.): <br />1.2 I.RS. Tax I.D. No. or Social Security Number: <br /> <br />2. Operation name (art. mine or site Hamel: Hazel tl ne Ml ne / <br />3. Permitted acreaEe (new or sestina site): <br />3.1 Change in acreage (+) <br />3.2 Total acrease in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Qnazry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />~. Primarvcommoditiels)tobemined: sand gravel <br />5.1 Incidental commoditie(s) to be mined: 1. 901 d _ 6.2 5 165/'k~/vr <br />3. / [bs/I-onslyr 4. ! 1bslTonslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />permitted a,:res <br /> acres <br />203.9 acres <br /> <br />$2344.W application fee <br />$2,906.00 quarry application <br />$1,938.00 amendmearfee <br />as"2,344.00 wnversion fee <br />2. / lbs/Cons/vr <br />5. / lbsl'I-onshr <br />construction materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: unknown <br />