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STATE OF COLORADO <br />DIVISION OF RKLAMATION, MINING AND SAFEiY <br />Department of Natural Resources <br />7313 Sherman SL <br />Room 215 p ~ ~ ~ 1 ~ ~~ <br />CF <br />, C O L O R A D O <br />Denver, Colorado 80203 FEB 0 1007 t <br />Phone: (30318663567 LAMATION <br />REC <br />FAX: (303) 832.8106 Division nt RF,rjr;ruij®n MINING <br /> Mining~nd8nftity F <br /> SA <br />ETY <br /> CONSTRUCTION MATERIALS <br /> LIMITED IMPACT (I10) OPERATION sill Owes <br />Gosemor <br /> RECLAMATION PERMIT APPLICATION FORM Russell George <br /> EaKUtive Director <br /> Ronald W, Canany <br />CHECK ONE: There is a File Nnmber Already Assigned to this Operation Division Director <br /> Natural Resource Trustee <br />Pertttit # M -_ _ _ (Please reference the file number currently assigned to this operation) <br /> New Application (Rule 1.4.5) Amendment Applica tion (Rule 1.10) <br /> Conversion Application (Rule l.t l) <br />Permit # M - ~ (provide for Amendments and Conversions of misting permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclaa~tion Pert contains three nmjor parts: (I) the <br />application fomt; (2) Exhrbils A-l, Exhibit L, Addendum 1, any sections ofExhibit 6.5 and Geotechnicat Stability Exhibit, as roquired <br />by the Office, and ouUitxd in Rules b.l, 6.2, 6,3, b.5, and 1.6.2(t xb); and (3) the application fee. When you subnrit your application, be <br />sure to include one (I } complete sitmed and notarized ORIGINAL and one (1 } copy ofthe completed application form, two (2) copies <br />of Exlu'bits A-l, Exhtbit L, Addendum 1, and appropriate sections of 65 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 81/2" X <br />11" or 8 1/2" X 14" size. To expedice processing, please provide the information in the format and order described in Otis form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, ALL in-fror~matli/on Id'e~criQbe~d ~beJbw. <br />1. Aponcant/ocentor or comoanv game (name to be used on cermi0: ~L~ .ice t7. d.~f9C(~P. <br />1.1 Type of organization (corporation, partrtership, etc.): Y <br />2. Operation name (pit, mine or site par>KI: ni2Pd I P. l~~fy <br />3. Permitted acreage (new or e>3attne aitel: permitted acres <br />3.1 Change in acreage (+) n scree <br />3.2 Total Acreage in Permit Area q,q ~ acres <br />4. Fees: <br />4.} NewAppiication: $1.(194.00 application fee <br />Amendment Fee (C.R,S. 34-32.5-125(II)): 719.00 application fee <br />4.2 Conversion Fee (from 1 IOd to 1 IO 875.00 conversion fee (Rule~1._1'1_.2(2)) <br />5. Primary commoditie(s) to be mined: ~~,uD~YI~T 1~ t~R~S~O~Ot~I.~IVQ, Ri>C-~-~ C-iTp,N~t ~ti'~ <br />5.1 Incidental commoditie(s) to be "mine"A:~I ~ / lbs/I'ons/vr 2. / Ibs/fons/vr 3. / lbs/fons/vr <br />4. / ibs/1'onsivr 5. / IbsrTonsFvr <br />5.2 Anticipated eud use ofprimary cotrttrwditie{s) to be mined: ~iOQC~COVC' f~ 11(I (] nd I Qllrl~r' l~flq <br />Anticipated end use of incidental corrvmditie(s) to be mined: ~ Yl[~5(Q () G <br />~re of _ Oifice of <br />~~ ~ ~ ~ ~ ~ ~` - Active arM Inactive Mines <br />