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STATE OF COLORADO <br /> DIVISION Of MINERALS AND GEOLOGY <br /> Department of NaturarResources <br /> 1313 Sherman St., Room 215 RECEIVED <br /> Denver.Colorado 80203 <br /> Phone:003)866-3567 WN <br /> FAX:(303)832.8106 3 i 1999 <br /> DEPARTMENT O <br /> avis)on o!Minerals&Geology NATUM <br /> CONSTRUCTION MATERIALS SOURCE. <br /> LIMITED IMPACT (110) OPERATION G�rprr <br /> RECLAMATION PERMIT APPLICATION FORM lames S.Lochhead <br /> Executive Director <br /> Michael B.Long <br /> Division Director <br /> CHECK ONE: X Now Application (Rule 1.4) Amendment Application (C.R.S. 34-32.5-110) <br /> Conversion Application (Rule 1.11) <br /> Permit (< - - (-1 � -_ (provide for Amendments and Conversions of <br /> existing permits) <br /> The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit <br /> contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, <br /> any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and <br /> outlined in Rules 6.1, 6 .2, 6.3, 6.5, and 1.6.2 (1) (b) ; and (3) the application fee. When you <br /> submit your application, be sure to include one (1) complete'signed and notarized IVORY ORIGINAL <br /> and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A-J, <br /> Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit) , as <br /> required, and a check for the application fee described under (4) below. Exhibits should NOT be <br /> bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To <br /> expedite processing, please provide the information in the format and order described in this <br /> form. <br /> RAL OPERATION INFORMATION <br /> Type or print clearly, in the space provided, ALL information described below. <br /> --------------- <br /> ---------------------------------------------------------------------------------------------- <br /> 1. Applicant/operator or company name (name to be used on permit) : <br /> Rio Blanco County Road and Bridge <br /> 1.1 Type of organization (corporation, partnership, etc. ) : County Government <br /> 1.2 I.R.S. Tax ID No. or Social Security Number: 84-6000798 <br /> 2. Operation name (pit, mine or site name) : Red Wash Gravel Pit <br /> 3 . Permitted acreage (new or existing site) : 9. 99 permitted acres <br /> 3.1 Change in acreage (+ or -) acres <br /> Total Acreage in Permit Area 9 . 99 acres <br /> 4. Fees: <br /> 4.1 New Application $875 .00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125 (II) ) $575.00 application fee <br /> 4.2 Conversion Fee (from 110d to 110 87$ 5 .00 conversion fee (Rule 1.11.2 (2) ) <br /> 5. Primary commodities) to be mined: Gravel <br /> 5.1 Incidental commoditie(s) to be mined: 1. Gra vpl - 20FOO O lbs/Tons/yr <br /> 2 . / 1bs/Tons/yr 3 . / lbs/Tons/yr <br /> 4. / lbs/Tons/yr 5 . ! lbs/Tons/yr <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/Rip Rap <br />