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DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources DEC 0 3 2002 '~ <br />1313 Sherman St., Room 275 <br />Denver, Colorado 80203 D I V I S I O N O F <br />Phone: 1303) 866-3567 F~ LE COPY Division of Minerals and GeBlBgy MINERAL S <br />FAX: (303) 832-8106 b /t 6i <br />~0/] [+/~ /1 A/N~N~I G E O L O G Y <br />J4f1iM REC 4AMATION <br />CONSTRUCTION MATERIALS / MINING•SAFETY <br />REGULAR {112) OPERATION <br />BiII Owens <br />RECLAMATION PERMIT APPLICATION FORM Governor <br />-^ - Greg E. Walther <br />Executive Director <br />CHECK ONE: There is a FDe Nyt{isber Already Assigned to this Operation <br />1'~/ // Ronald W. Cottony <br />Permit # M ° l 1 b -_ (Please reference the file nmmber currently assigned to this operation) Acr`"g orviston oirmor <br />New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.1 I) <br />Permit # M -_ -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation lteclatnation Pert contains three major parrs: (1) the application form; <br />(2) Exlibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geoteclmical Stability Exhibit; and (3) the application fee. When yon submit your <br />application, be sore to include one (1) comnlefe siffied and notarized IVORY ORIGINAL and one (1) copy of the completed Ivory application <br />farm, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geoteclmical Stability Exhibit, and a check for the application <br />fee descabed noder Section (4) below. Exhibits shanld NOT be bou¢d or in a 3-ring binder maps sliwld be folded to 81/2"X 11" or 8 1/2" <br />X 14" size. To expedite ptncessing, please provide the information in the format and order described in this form. <br />GENERt1L OPERATION INFORMATION <br />Type or print clearly, in the space provided, AI,L information requested below. <br />SH (,''Nulty <br />h. AunlicanUocerator or comnany name tname to be used on nermitl: D. G. f'E~SKrA/ it 1iY1!~17LA{'-1im'l ~'~, <br />1.1 Type of organization (corporation, partnership, etc.): C/ w¢poitrt-ri on/ <br />12 I.RS. Tax I.D. No. or Social Sectuity Number: ~ ( <br />2. Ooeration name (art, mice or site Hamel: I~ELFNiDG l~rT <br />3. Permitted acreage (new oc esistino_ site): <br />3.1 Change in acreage (+) <br />3.2 Tota'. acreage i,'t Perv.it area <br />4. Fees: <br />4. I New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.i Conversion to 112 operation (set b}' statute) <br />~. Primary commoditie(s) to be mined: sA.lA R v _ <br />5.1 Incidental wmmodi[ie(s) [o be mined: 1. ~A - IbslTo¢slvr <br />3. / Ibs/Tons/vr 4. I lbs/TonshT <br />~OrJ pz~itted ac: es <br />"- acres <br />3no acre:, <br />2 344.00 lication fee <br />52 90 . quarry applicatio¢ <br />51.938.00 amendtue a fit <br />x2.3.14.00 conversion Fee <br />2. / 1bS/fOIIS/YT <br />5. / 1bsrTonslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: CoAl577ZU~T1o.J /y~i47~~t.Rs-s <br />5.3 Anticipated end ¢se of incidental commoditie(s) to be mined: /~[~ <br />