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~~7~ O~ COLORADO <br />DIVISION OF MINERALS AND GEOLOGM <br />Depanmrm of Natural Resources <br />I } 13 Sherman jl.. Ruom 21 i <br />Dem~er, Colorado BU?03 <br />Phonr' I ;03) Y,66-7567 <br />FAB 130}185'_-0706 <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />r ~-~~1~~ <br />.•- <br />r f ., <br />~P~ 1 ~ ~~~© e~~y <br />DI`/I SION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />nI NiNG•SAFETY <br />a~u awen. <br />Cu~rrno~ <br />Gre6 E. Walther . <br />RECLAMATION PERMIT APPLICATION FORM E>,ecun~e D~reaor <br />Michael B. Long <br />Divrsron Drrecror <br />CHECK ONE: ~ New Application (Rule 1.4) Conversion Application (Rule 1.11) <br />Amendment Application (C.R.S. 34-32.5-1 l0) <br />Permit # M 1(~ Q~~ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials L'united Impact (110) Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exiubia A-J, Exhiba L, Addrndum 1, arty sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules <br />6.1, 6.2, 6.3, 6.5, and 1.6.2(I)(b); and (3) the application fee. When you submit your application, be sure to include one (1) comolete sieved and <br />notarized IVORY ORIGINAL and one (1) copy of the completed lvorv application form, two (2) copies of Exhibiu A-], Ezhibit L, Addendum 1, and <br />appropriate sections of 6S (Geotechnical Stability Exhibit), as required, and a check for the application fee described cadet (4) below. Exhibits should <br />NOT be bound or in a 3-ring binder, maps should 6e folded to 8 12" X 1 I" or 8 12" X 14" size. To expedite processing, pleaze provide the information <br />in the formaz and order described in this form. <br /> GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL informstioo described below. <br />~ <br />1. A~olicaotlooentor or comoaov Dame (name to be used on oermitl: DE[_ 1-1 U(L SF.tpt7`zY 2 lE S YFJ L. <br />l .l Type of organization (corporazion, partnership, etc.): (' a flPo iz A +: o nl <br />1.2 I.R.S. Tax iD No. or Social Security Number: ~{ I I S ~ 1(e <br />2. OQentionname(oit,mineorsitename): Mr ICEN1.1[~ (rlMESItl~IE QJA0..fL`( <br />3. Permitted acreage (new or existing skel: !a permined acres <br />3.1 Change in acreage (+) _/ O acres <br /> Total Acreage in Permi[ Area _.J n acres <br />4. Fees: <br />4.1 New Application: 75.0 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(11)): 575.00 applicazion fee <br />4.2 Conversion Fee (from I 1 Od to 110 575.00 conversion fee (Rule I.l 1.2(2)) <br />r~y~ <br />5. Primary commoditie(s1 to be mined: Gfn^!E S ~E Zo 1'~S ti• S ~IALC 5~ y ^' <br />>.I Incidental commoditie(s)tobemined: I. Ibslions/yr 2. /~IbsffOrlS/vr 3. / Ibslfons/vr <br /> 4. / Ibs/fons/vr 5. / Ibs(fons/vr <br /> <br />5? <br />Anticipated end use of primary commoditie(s) to be mined: /~~ P 2Ap ~ Et20°i;oAl COAI~reG~ A <br />f°,INE D/A.naJ,[ h7A6'Gz• ~ <br />53 Anticipated end use of incidental commoditie(s) to be mined: g i2o"+a /3ASE 20CIL ~if'EU.INATibJ SrJ,L <br />