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~ ~ <br />STATE OF COLORADO <br />DIVISION Of MINERALS AND GEOLOGY <br />Dcparlmenl of Natural Resources <br />111 { $hcrman $L, Room 215 <br />Ucnvcr. Colorado A0203 <br />I'hunC ({1111 A6fi~J Sfi7 <br />FA%: 1 1031 A iZ-8106 <br />JUG` Q ~ 1.gy6 <br />~~~ <br />DEPARTMENT Of <br />NATURAL <br />CONSTRUCTION MATERIALS RESOURCE` <br />REOULAA OPBRATION (112 ) pivi~mn HI nbngi qiV A tigRlgq~Roy Romer <br />RECLAMATION PBRNIT APPLICATION FORK Governor <br />lames 5. Lochhead <br />E.eculrve Duttmr <br />Michael B. Long <br />Dna~un Direclar <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />X Convcrsion Application (Rule 1.11) <br />Permit f - -_ (provide for Amendmeats and Conversions of <br />existing permits) <br />The application for a Regular 112 Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical <br />Stability Exhibit; and (3) the application fee. when you submit your application, be sure to <br />include one {1) complete sinned and notarized IVORY ORIGINAL and four (4) copies of the completed <br />ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 <br />(Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) <br />below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br />or 8 1/2" X 14'• size. To expedite processing, please provide the information in the format and <br />order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly in the space provided the information requested below. <br />1. Aaplicant/operator or company name (name to be used on permit): <br />RIO BLANCO COUNTY <br />1.1 Type of organization (corporation, partnership, etc.): C;OVERNMFNT <br />1.2 I.R.S, Tax I.D. No. or Social Security Number: <br />2. Operation name (pit, mine or site name): pR l1TNG~ r.P °VEL PTT <br />3. Permitted acreage (new or existing site) r;-nn permitted acres <br />3.1 Change in acreage (+ or -) 31.59 acres <br />3.2 Total acreage in Permit area 37.59 acres <br />4. Fees• <br />4.1 New Application 51.875.00 application fee <br />4.2 New Quarry Application 52.325.00 quarry application <br />4.3 Milling Application (Non-DMO) 53,100.00 milling application <br />4.4 Amendment Fee 51,550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 51,875.00 conversion fee <br />5. Primary commod it ie(si to be mined: <br />5.1 Incidental commoditie(s) to be mined: 1. 500 _ 15,000 lbs/Tons/vr <br />2. 15~Q00 / 30,000 lbs/Tons/vr 3. 30,000 / 45,000 lbs/Tons/vr <br />4. [}$000 / 60,000 1bs/Tons/vr 5. 60,000 / 75,000 lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ROAD SURFACING <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: BEDDING <br />