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999 � <br /> STATE OF COLORADO <br /> DIVISION OF MINERALS GEOlOG11L- _ Rece- <br /> Ihrparvnrm of Nanval Re,ource5 cesved <br /> I H I Sherman St., Room 115 <br /> Denver,Colorado 8203 J=� AUG D 1 V 1 5 1 0 N O F <br /> Phone:f II)31 Ithf,-35F�7 3 11999 MINERALS <br /> FAX:1.10 R It 11 8106 � & <br /> GEOLOGY <br /> prango Field pry R E C L A M A T I O N <br /> ofMineryls' ice Geology MINING-SAFETY <br /> CAE �] ERI LS <br /> L 81110 <br /> LIMITED IMPA TION Governor <br /> RECLAMATION PERMIT APPLICATION FORM Greg E.Watcher <br /> Eaecmive D,,wor <br /> Michael a.Long <br /> Division Dlncwr <br /> CHECK ONE: _�_ New Application(Rule 1.4) Conversion Application(Rule 1.11) <br /> Amendment Application(C.R.S.34-32.5-110) <br /> Permit k M - ----,�s3Pa(provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Limited Impact(110)Operation Reclamation Permit contains three major parts: (1)the application form; <br /> (2)Exhibits A-J,Exhibit L,Addendum 1,any 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(1)(b);and(3) the application fee. When you submit your application, be sure to include one(1) complete signed and <br /> notarized IVORY ORIGINAL and one(1)copy of the completed Ivory application form,two(2)copies of Exhibits A-J,Exhibit L,Addendum 1,and <br /> appropriate sections of 6.5(Geotechnical Stability Exhibit),as required,and a check for the application fee described under(4)below. Exhibits should <br /> NOT be bound or in a 3-ring binder,maps should be folded to 8 12"X I I"or 8 12"X 14"size. To expedite processing,please provide the information <br /> in the format and order described in this form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided, ALL information described below. <br /> I. Applicant/operator or company name(name to be used on permit): o. v tt <br /> 1.1 Type of organization(corporation,partnership,etc.): .SkW <br /> 1.2 I.R.S.Tax ID No.or Social Security Number: 5 2 J4 7 Z Z i Z.I <br /> eR <br /> 2. Operation name(pit,mine or site name): <br /> 3. Permitted acreage(new or existine site): �_permitted acres <br /> 3.1 Change in acreage(+) acres <br /> Total Acreage in Permit Area 9 acres <br /> 4. Fees: <br /> 4.1 New Application: $875.00 application fee <br /> Amendment Fee(C.R.S.34-32.5-125(il)): $575.00 application fee <br /> 4.2 Conversion Fee(from I I0d to 110$875.00 conversion fee(Rule I.I 1.2(2)) <br /> 5. Primary commoditie(O to be mined: s t G r o,yR-I <br /> 5.1 Incidental commoditie(s)to be mined: 1. Cr'll / Iomlbs/Tons/yr 2. Ibs/fons/vr 3. Ibslfons/yr <br /> 4. / Ibs/fons/vr 5. / Ibs/fons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: Go is <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: Fi <br />