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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1373 Sherman St., Room 215 <br />Denver, Colorado 80203 DIVISION O F <br />Phone: (303) 666-3567 RE(; E' VED MIN &RA L S <br />FAX <br />GEOLOGY <br />AN 0$ RECLAMATION <br />0 PY CONSTRUCTION MATERIALS J 2003 <br />FOR SCANN/NG (112)OPERATION ~i~isian MINfNG•SAfETY <br />REGULAR of Minerals and Geol <br />RECLAMATION PERMIT APPLICATION FORM ®ipwens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: ~_ New Applicaflon (Rule 1.4.5) _ Amendment Application (Rule 1.1 ichael B. Long <br />Qivision Director <br />_ Conversion Applicaflon (Rule 1.11) <br />Permit# M -~~3-0©~ __ (provideforAmendmentsandConversionsofexisting permits) <br />The application for a Construction Ivlatedals Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the applicaflon fee. When yvu submit your <br />application, be sure to include one (1) complete sieved and notarized IVORY ORIGINAL and four (4) copies of the completed Ivorv <br />applicafion form, five (5) copies ofPxhibits A-S, Addendum 1, appropriate secfions of 6.5 (Geotechnical Stability Exhibit, and a check for the . <br />application fee described under Secflon (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 lYl" X 11" <br />or 8 1/2" X 14" size. To expedite processing, please provide the informafion in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />Anplicant/operator or comnanv name (name to be used on oermitl: Westside Gravel, LLC <br />1.1 Type of orgattizafion (corporation, partnership, etc.): Limited Liability Company <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. O~teration name (oit, mine or site name); <br />Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />4. Fees <br />~ 00 permitted acres <br />acres <br />100 acres <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarry Application $2.906.00 quarry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Primary commoditie(sl to be mined: 4ravel sand <br />5.1 Incidental commoditie(s) [o be mined: 1. - lbs/pons/vr <br />3. / lbs/I'ons/Kr 4. / lbs/I'ons/vr <br />Westside Gravel <br />2. / lbs/pons/vr <br />5. / lbs/Tonsfyr <br />5.2 Anticipated end use of primazy commoditie(s) to be mined: road base, asphalt & concrete aggregates <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />