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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources RECEIVED <br />1313 Sherman St, Room 215 C O L D RA D O <br />Denver, Colorado 80203 DIVISION o r <br />Phone: (303) 866-3567 CONSTRUCTION I4IATERiATS SEC ~ ~ 9 20Q5 M I N E~ RA L S <br />FAX: (303) 832$106 REGULAR (f 12} OPERATION G E O L O G Y <br />OivisionOfMineralsandGeolo ECLANATION•NINING <br />RECL.AMATIONPERMITAPPLICAITONFORM B SAfETT•SCIENCE <br />Bill Owens <br />Govema <br />CHECK ONE: There is a File Number Already Assigned to this Operation Russell George <br />Permit # M -_-_ _ (Please reference the file number currently assigned to this operation) Ezecuttve Director <br />New A lication ule 1.4.5 _ Amendment A lication ule 1.10 Ronald W. Cottony <br />pp (R ) pp (R ) Division DireROr <br />Conversion AppGcahon (Rule 1.1 I) wtuml Resource Trustee <br />Permit # M -^ -_ (provide for Amendments and Conversions of existing permits} <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three majorparts: (1) the application form; <br />(2) Exlribi[s A-S, Addendum 1, any sections ofExhibit 6.5 (Geotechnical Stability Exlu'bit; and (3) the application fee. Whenyou subtnityoru <br />application, be sure to include one (I) complete sinned and notarized ORIGINAL and one (1) copy of the completed applicationfann, two (2) <br />copies of Exhibits A-S, Addendum 1, appropriate sections of 6.S (Geotechnical Stability Exhibit, and a check for the application fee desmbed <br />under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to 8 1 P2" X 11" or 81/2" X 14" size. To <br />expedite processing, please provide the information in the format and order descnbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, io the apace provided, ALL information requested below. <br />1. AHHlicant/operator or combany name (name to be Hoed on Hermit): t`~ I~~ 51,./ Gro.n ~n! <br />{1 -rn ,~j <br />1.1 Type of organization (corporation, partnership, etc.): ~ Vn rf'eJ < ri+ / (C5~ ~>^ n-~-,i <br />n ~„ <br />2. Operation name (Hit. mine or site Hamel: G IP.,n S t" r^E' <br />3. Permitted acreage (oew or e:ist(n¢ sitel: <br />3.I Change xi acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Prlmary commoditie(s) to be mined: ~ _ <br />5.1 Incidental commoditie(s) to be mined: 1, t7 ~'`d`~ 2 !bs ~ori <br />3. / 1bs/Tons/vr 4, / Ibsffons/vr <br />3 5 • ~ ! permitted acres <br />-"" acres <br />•3 S. 51 acres <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2~"~' 1 / ~Q b 1'0° <br />S. / Ibs/fons/vr <br />S.2 Anticipated end use of primary commoditie(s) to be mined: t'ro~rn S <br />5.3 Anticipated end trse of incidental commoditie(s) to be mined: O. A<.n~ 7~i~..~tr~s <br />Office of <br />Colorado <br />