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<br /> <br />• DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman S[., Room 215 <br />Denver, Coloradr, 80203 <br />Phone: (303) 866-3567 <br />FAX: (303)832-8106 <br />RECEIVEF~'~~o~ <br />~'~ <br /> <br />STATE OF COLOIZf~DO <br />L^'3 e°'TR <br />F3~~.~__ ~; .:.;.~ <br />~!OV Z ~~ 2~~09 ~~`~~~~ ,~-~ <br />DIVISION OF <br />Dieision of Minerals and Geology ~!t,~1 ~ - W~~~ MIN &RA L S <br />CONSTRUCTION MATERIALS G E O L O G Y <br />pieision of Minerals and Geology R E C L A M A T I O N <br />MI NING•SAFETY <br />LIMITED IMPACT (110) OPERATION <br />DEC 31 2001 RECLAMATION PERMIT APPLICATION FORM OolveDrnor s <br />Greg E. Wal<her <br />Executive Director <br />DIYISIOa of Minerals and Geology Michael 8. long <br />v on Director <br />CHECK ONE: New Applicafion (Rule 1.4) .Conversion Application (Rule .~)`} <br />Amendment Application (C.R.S. 34-32.5-110) <br />Permit # M -~Q1t -~-_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construcfion Materials Iamited Impact (110) Operation Reclamafion Permit contains three major pazis: (1) the application form; <br />(2) Exhibits A-J, Exhibit h Addendum 1, any sections of Exhibit 6.5 and Geotechnical StabllityExhibi4 as required by the Office, and outlined in Rules <br />6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one (1) complete signed and <br />notarized IVORY ORIGINAL and one (1) copy of the completed Ivorv application form, two (2) copies of Exhibits A-J, E~dtibit L, Addendum 1, and <br />appropriate sections of 6.5 (Geotechnical StabilityExhibit), as required, and a check for the application fee described under (4) below. Exhibits should <br />NOT be bound or in a 3-ring binder; maps should be folded to 8 12" X 11" or 8 12" X 14" size. To expedite processing, please provide the information <br />in the forma[ and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />ApplicantJoperator or company name (name to be used on permit): LOUKOGI ErJ f~Q05 • STO1J E: C6 . <br />1.1 Type of organizafion (corporation, paztnership, etc.): <br />1.2 LR.S. Tax ID No. or Social Security Number: <br />Operation name (nit. mine or site name): 5 ~ AQ 1(S QtA A Q Qy <br />Permitted acreage (new or existing site): ~l . I Z permitted acres <br />3.1 Change in acreage (+) acres <br />Total Acreage in Permit Area acres <br />Fees: <br />4.1 New Applicafion: $1.094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): 719.0 application fee <br />4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />Primary commoditie(s) to be mined: SA/SOSTDIJ IE <br />1 5.1 <br />I•.2 <br />Incidental commoditie(s) [o be mined: I. SAa05riA4 Sooe $ldfons/v_r 2. / lbs/1'ons/vr 3. / lbs/I'ons/vr <br />4. / lbs/Tons/vr 5. / lbs/Tons/vr <br />Anticipated end use of primazy commoditie(s) to be mined: G~NSr Rucr roil / L A.r~SCa P W / Yh a r F Brat S <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />