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RECEIVE® <br />~~~ , ~ X097 ST~T~ of coLor~Do <br />- - --- D~tt,t~~r~n ------- --------- ----- - - <br />DIVISION OF R[CL.AMATION, MINING AfJO'QAAE PFd "°1°•1 <br />Department of Nelu~al ReSOwces <br />1313 tihertnan $r, Roam ? 15 <br />COLORADO <br />Denver, Culoado 80203 n i v i s i O N O r <br />Phone: 1303) H66-3567 CON5T}2UC'P[ON 1~IA'I'ERIALS RECLAtiWT10N <br />Pnx: i.3o31 x32-sloe MIN 1 NG <br />RISGLq.AIi (112) OPN:ILATH)N <br />-&- <br />RF,CLAD1ATIOti PliRVIIT:SPPLICATION FORM SAF@TY <br />gill O,ro~s <br />Gorernnr <br />CHECK ON1;.: _ 'there is n File Hnnther Alrcad}~ Assigned to this Operation <br />Russell leeorar. <br />Permit # M - _.__ _ (I'Iease reference the file number cwnntly assigned to this operaffiH}11Ve oo-enor <br />R~n~ia vv. c. u.,nr <br />,__ New Application (Rule 1.4.5) Amendment Application (Rule 1.10} olvf.loa orroevr <br />__ Conversion Application (Rule 111) Nawrel Rrsoarcc T.~;n«~ <br />too <br />Permit t! M -~lr~~-~ (provide for Amendments and Conversions of existing perntits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Penuit emnains tlvee major parts: (I) the application <br />form; (2) Exhibits A-S, Addendmn 7, any seetious of Ex)tibit G.5 (Cieofechpical Stability F;xhibit; and (3) the application fee. When you <br />submit your application, be sure to inchrde one (1) complete sieved and notarized ORIGtNAt. autl mte (1) copy of the completed <br />application fain, nvo (2) copies of F;xhibits A-S, Addendum 1, npyropriate sections of 6.S (Gcotecbnical Stabitity Exhibit, and a check for <br />the application fee described ender Section (4) below. Exhibits should NOT' be bound or in a 3-ring binder; maps should be folded to <br />8 1 /2" X 11" or S 1(2" X 14" size. 'I'o expedite processing, please provide-the information in the format end order described in this fmnr. <br />GENERAL OPERA'f10N INFORMAT}ON <br />Type m• print clearly, in the space provided, ALI, information requested below. <br />n tI <br />1. Anplicmrdonerntor or cwnpm+y name !name to be used on permit): ~ ~ ~ l ~ ~ vhi(_, ~' ~ 1~~L~Of I Tl~ <br />L l Type of m~ganization (coryoration, parttership, ero.): __ __.__._ _ <br />2. lll~eration name (pit. mine or site mm~el: ~~-Ci~NZ~~/_ILL'~:~~1~ <br />~ <br />3. Permitted acreage !new m• existine site!: _ permitted acres <br />3.1 Change in acreage (+) _______ _ __,_.. acres <br />3.2 'total acreage in Permit m~ea aa~s <br />4. Fees: <br />4.1 New Applicatimt $244.00 _ applicatimt fee <br />4.2 New Quarry Application ~2~OG,00 quarry npplieatinn <br />4.4 Amendtnent Fee r ,'~;/~~~ amendment fee <br />4..5 Conversion to ] ] 2 uperatiuu (scl by slutute} _$2 344.00 ,_ conversion fee <br />5. Primary convnoditietsl to be mined: 11~ e'~'~11~~~ <br />~ <br />5.1 Incidental conunoditie(s) to be mined: L -__.__.. <br />__.______Ib~%f. ons/vr 2. ~_ ! ____ _ lFte[['nnsl~ <br /> 3. ______ i ____ ___ Ibs;'fons~ 4. _. __= - Ibs,'I'o <br />n <br />_ <br />/~T <br />5. __ / Ihs;'I'onslY <br />52 L <br />~ <br />s <br />( <br />Anticipated end use of primary conunodhie(s) to be mined: _CQ{~' JLl IB ~~j C'R-l<_ _____._ _____.______ <br />5.1 Anticipated end nse of incidental cemrrtoditic(s) to be mined: <br />Office of b(fice of <br />Mined Land Recl:+malion Active and Inactive Mines <br />