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<br />n, <br />• ', ~ Il <br />;`~ ~~ ~ ~ 1~ ~~ ~~L~l~~~ <br />i~ <br />De[~rlm7ml of NacuralJtesources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Fhonc: 1303V 8fib-3567 <br />FAl(: 13031 8328106 <br />REGf77rAR (1124) <br />New. Application <br />_ Conversion Applic <br />Permit No. M-~_- <br />The application for a Regular (112 ) DesignatQd Mining. Operation Reclamation Permit <br />contains three major parts: (1) the application form; (2) Exhibits A-T, Geotechnical <br />Stability Exhibit; thg Emergency Respo se Plan, an't3 Addendwll 1, as required by the Office, <br />and outlined in Rules 6..1, 6.2, 6.3 6.4.19, 6.5, 8.0, and 1.6.2(1)(b); ~, (3) the <br />.application fee. When you submit your application, be sure to include one (1) eirntad and <br />notarizyd Grs~y„origj,}}al and four (4) copies of the application form, five (5) copies of <br />",Exhibits A-T, Geotechnical Stability E ibit, the Emergency Response Plan, Addendum 1, and <br />a cheek for the appropriate applica ion fee (described under Section (4) on Page 2). <br />Exhibits should not be bound or in a -ring binders; maps should be folded to 8 h"'X 11" <br />or 8 ~" X 14" size. To expedite proi(;e sing, plea$e provide the information in the format <br />`. and order described in this form. <br />GENERAL OPERATION TNEORMATION <br />Type or print clearly, in the sp ce provided, all information described below. <br />1. <br />`. <br />x;~s.,. <br />,`:•. <br />- ~. <br />~z. <br />3. <br />C" <br />~~ <br />~.. <br />!c. <br />1::. <br />1.1 Type of organization <br />1.2 I.R.S. TAX ID No. or S <br />Pormi.tta screag4: (new or e~xi~s <br />3.1 Change in acreage (+ or -) <br />3.2 Total acreage in Permit ax <br />DHSIGN7l;T8D MI <br />cru~n-TION .P$R24'!T <br />F~+S,ICATION FORH <br />flap Rnmer <br />Governor <br />James 5. Lothhead <br />ExecuGre Dueaor <br />Michael 8. Long <br />Division Director <br />1:4.5) ~ Amendment Application (Rule 1.10) <br />(Rule l.ll) <br />(provide for amendments and conversions of <br />existing permits) <br />ation, partnership, etc.) : Jl7tnt ((([tiro C! <br />Security Number: ~ ~. ~ 2~hS"//Z <br />„~; CJ~san 6~M~2cfi' <br />site) ~ ZO2~•Go permitted acres <br />~' ZD S~ acres <br />Z a. / acres <br />. _ .... rr.$F....... r._ ,...sue .4_."f`~!a~ _ > ~v{~r., _ ...k. . ~. - , „fir., : y~;: <br />RECEIVED <br />~u~ 3 t tie . <br />DIV. OF MINERALS <br />GY <br />