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TATE OF COLORADO <br />DIVISION OF MINERALS ANO GEOLOGY <br />Department of Natural Resources <br />53135herman 5l., ROOm 215 6~ECEIVED COLORADO <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS DIVISION o E <br />Phone: (303) 86b35G7 MINERAL S <br />FAX: (303) 83z-Sto6 REGULAR (112) OPERATION MAR 16 2004 G E O LO G Y <br />RECLAMATION PERMIT APPLICATION FORM RECLANATION•NINING <br />DivisionolMinerals&Geolog SAFETY•SCIENCE <br />CI{FCK ONE: There is a File Number Already Assigned to this Operation <br />ZGO. Z pc~mitted acres <br />Permit # M -~ ~r7(Please reference the file number currentl assi ed to this o ation Gres E. watcher <br />~- y t'^n i~ ) Execurive DIRCIIN <br />New Application (Rule 1.4.5) ~ Amendment Application (Rule L 10) Ronald w. caaany <br />Division Director <br />Conversion Application (Rule L I i) Natural Resource Trustee <br />Permit # Iv _- -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) the application form: <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability F.xhibil; and (3) the application fee. When you submi[yoElr <br />application, be sure to include one (I) complete sierted and notarized IV ORY ORIGINAL and one (1) copy of the completed tycxv application <br />form, riyo (2) espies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee dcs<;ribed under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be t'olded to 8 I /2" X 11"or 8 12" X <br />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 deedy, in the space provided, ALL information requested bebw. <br />1. Aoolieaotlooerator or rnmnanY Dame (name to be used on oermk): .//I //• ~anci~;Le ~dn s~idcfi a n <br />I . l Type of organization (corporation, partnership, etc.): to /o ra da io r~ o/a~, orI <br />12 LR.S. Tax LD. No. or Social Security Number <br />2. Ooeratioo name (oil. mice or site name): _ L~ OBE I.PAyEZ ~ T <br />3. Permitted acreatte (new or existing site): <br />3.1 Change m acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4. I New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />45 Com~ersion to 112 operation (set b}'statute) <br />5. Priman° commoditie(s) to be mined: ~grl~ rave / <br />5.1 [ncidentai wmmoditie(s) to be mined:~VA. - lhslConsh~ <br />7. ! Ibs/Ton_Jvr 4. ! Ibs/ToaJt'r <br />Bill Owens <br />Goverrwr <br />acres <br />acres <br />$2 344.00 application fee <br />$2.9(Ki.00 quarry application <br />$1.938.00 amendmentf'ee <br />$2 344.00 cum~enion lee <br />~ / lbsll'onslvr <br />5. / Ibs/fonsh~r <br />5.2 Anticipated end use of ptiman~ commoditie{s) to be mined: Ce n S'7</rlGTion rnGl7C/ig / <br />5.3 Anticipated end u~ of incidental erorranodi[ie(s) to be mined: vV. ,Q. <br />