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~~~E°~~® STATE OF COLORADO <br />~IVISION OF MINERALS AND GEOL <br />10313 Sherman StatRoom 275rce~lvision of lyllaerals aa1 GeologP <br />Denver, Colorado 80203 D [VISION O F <br />Phone: (303) 866-3567 MINERAL S <br />FAX: (3031832-8106 CONSTRIICTION MATERIALS & <br />GEOLOGY <br />LIlVIITED IMPACT (110) OPERATION ~ R E C L A M A T I O N <br />~~~~ ^®~~ MININ G•SAFETY <br />~p 'J~9" (~ ~©~® RECLAMATION PERMTf APPLICATION FOBM <br />Greg E. Walther <br />CHECK ONE: There is a FOe Number Already AasigRed to thin Operation Executive olrector <br />Ronald W. Canny <br />Pemrit # ~-_-_-_ (Please reference the fde number currently assigned to this operation) ~1in8 Division Director <br />~_ New Application (Rule 1.4.5) Amendment Application (Role 1.10) <br />Converabn Application (Rule 1.11) <br />Permit # ~_-i~ ~-~~-_ (provide for Amendment and Converelone of eltistmg permits) <br />The application for a Constriction IvlateriaLc Limited Impact (110) Operation Reclamation Permit contains three major part: (1) the <br />application fomL; (2) Exhbity A-J, Exlubft I, Addendum 1, any sections ofExhrbd 6.5 and Geotechnical Stability ExMbit, as regnirod by the <br />Office, and outlined in Roles 6.1, 6.2, 6.3, 6.5, and 1.62(1)(6); and (3) the application fee. When yon submit your application, be sore to <br />include one (1) comps and notarized IVORY ORIGINAL and one (1) copy of the completed Ivry application fpm, two (2) copies <br />of Exhibits A-J, Exlubi[ L, Addendum I, and appropriate sections of 6.5 (t.;eotecl[nical Stability Exhrbit), as required, and a check for the <br />applicatiaa<fee described under (4) below. Exhibits shanld NOT be bound or in a 3-ring binder, maps should be folded to 8 1/2" X 11" or <br />8 12" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />Cd;TIERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, ALL information described below. <br />]. Applicant/operetor or rnmpanv name (name to be used onpermhtl: dr l i t-haE L 8 flow ri i u G ~' <br />1.1 Type of otgamzahon (corporation, PP> etc.): O W Nt= iZ/ b A Eak To R <br />1.2 I.RS. Tax ID No. or Social SecirAy N~ber: 2.: . <br />2. Operation name loft, mine or afte name): ~(ET C Q K YO N ~. i N E <br />3. Permitted acreage (new or eaiatine aitel: ~. 9 permitted acres <br />3.1 Change in acreage (+) <br />3.2 Total Acreage is Permit Area <br />acres <br />Q. R acmes <br />4. Fees <br />4.1 New Application: X51.094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): 5719.00 application fee <br />4.2 Conversion Fee (fiom 110d to 110 5875.00 conversion fee (Role 1.11.2(2)) <br />5. Primary oommoditie(sh to 6e mined: S.4 ALD ~ R/a U ^' <br />r20~~ ~ <br />5.1 Incidental commoditie(s) to be mined: 1. / Ibs/I'ons/~ 2. / lbs/T'ons/vr 3. / Ibs/fons/vr <br />4. / Ibs/Toasl~r 5. / Ibs/T'ons/vr /' <br />5.2 Anticipated end use of prmrary commoddie(s) to be mined: ~or~D L~45£ /SR'YD f L7R'9U~L <br />Anticipated end nse of incidental commoditie(s) to be mined: NOSE <br />