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eeip~ 8151 ~1s75.oo <br />DI\'I SION OF MINERALS AND GEOLOGN <br />D:~p.lrlrnenl of ld Blur.r RevnlrCeS <br />Ia11 Sherman SL. Ruom 215 <br />Uenvcr, Qrlnrndo 80203 <br />Phone: LSQ31 8663 ibi <br />F,ix laoslx)2-nloe <br />RECEI!/ED <br />JUL 2 2 2~2 <br />Division of Minerals and GeologyDivisian of Minerals and Geology <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />OF ~OLORAL O <br />4 art s~ ...~ ...J <br />Jam: ~ 2 wit <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION- <br />MINING~SAFETY <br />Bill Owens <br />Governor <br />RECLAMATION PERMIT APPLICATION FORM Gres E. watcher <br />Executive Oirecwr <br />Michael B. long <br />Division Oirecmr <br />CHECK ONE: New Applicaton (Rule l.4) Conversion Application (Rule 1.11) <br />~G Amendment Application (C.R.S. 34-32.5-110) <br />Permit ri M -2000-090-_ (provide for Amendments and Conversions of existing permits) <br />The application For a Conswcfion Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-J, Ezhubit L, Addendum 1, any sections ofExhtbit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules <br />6.1, 6.2, 6.3, 6.5, and 1.6.20)(6); and {3) the application fee. When you submit your applicatioa, be sure m include one (1) complete simed and <br />notarized IVORY ORIGINAL and one (1) rnpy ofthe completed Ivory application form, two (2) copies of Exhibits A-J, Exhibit L, Addendtm 1, and <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should <br />NOT be bound or in a 3-ring binder, maps should be folded m 812" X 11" or 8 12" X 14" size. To expedite processing, please provide the information <br />in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, ii the space provided, ALL information described below. <br />Ap0licantJoperator or camoeov name (Dame to be used on 0ermit): LpI.IKOA) £rJ ~Q.OS . STd/J E <br />1.1 Type of organization (corporation, partnership, etc.): S Go R po l2Atlonl <br />L2 - LR.S. Taz ID No. or Social Security Number: <br />-000 <br />2. Operation name (nit, mine or site name): L_Y L21~1 S Gul-G H <br />3. Permitted acreaee (new or existint= site): q .9 permitted acres <br />3.1 Change al acreage(+) acres <br />Total Acreage in Permit Area ~_ acres <br />4. Fees: <br />4.i New Application: $875.00 application fee <br />Amendment Fee (C.R.$. 34-32.5-125(II)): $575.00 application fee <br />4.2 Conversion Fee (from I I Od to 110 8$ 75.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: SArlldSTOIUE ~OLAMIT~ <br />5.1 Incidental commoditie(s) to be mined: 1. X00/TONS Ibs?ons/vr 2. 5oG'-roAS Ibs/Tons/vr 3. / Ibs/Tons/vr <br />4. / IbslTons/vr 5. / Ibs/Tonsivr <br />5? Anticipated end use of primary commoditie(s) to be mined: 8UoI_L01x16 } t_R/.1`bSGAPE <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: TUf>~ BAS £ <br />