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<br />OF COLOIZf~DO <br />DIVISION OF MINERALS AND GEOLOGY <br />Orparlmenl of Natural Resnwc'es <br />I l l f Sherman Sr . Rwm ? l i <br />Denver, Colorado HU LU] DIVISION O r <br />Phone. 11011 ObLJSh' RECEIVED MINERAL S <br />FA%~. ;51711 R1bN106 <br />GEOLOGI <br />JUL 2 0 2001 RECLAMATION <br />CONSTRUCTION MATERIALS MINING•SAFETY <br />REGULAR (112) OPERATION Division of Minerals and Geology <br />RECLAMATION PERMIT APPLICATION FORM e~R Owens <br />Go•.emm <br />Cre(; E. Watcher <br />E.ecuuve Diieclor <br />CHECK ONE: _ New Application (Rule 1.4.5) _ Amendment Application (Rule I.10~'j;'~nael a Ln"s <br />. on Dneao~ <br />Conversion Applicaion (Rule I.1 I ) <br />Permit N M - 9.5 -~- V I (provide for Amendments and Conversions of existing permiu) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) the applicaton form; <br />(2) Exhibits A-S, Addendum 1, atry sections otExhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (t) complete sieved and notarized IVORY ORIGINAL and four (4) copies of the completed No <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described Imder Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />g IR" X (l' or g I I2" X 14" size. To expedite processing, please provide We information in the format and order described in this form. <br />OPERATION INFORMATION <br />Type ar print clearly, in the space provided, ALL informstiau requested below. <br />1. Aaolicant/ooerator ar comoaov oame (oame to be used on oermitl: ~}}N I EL /f'1 ~ /~ 055 E-L ~- <br />l.l Type of organization (corporation, partnership, etc.): .`~ L t O PERA7s~2 <br />1.2 LR.S. Tax LD. No. or Social Security Number: ,J Z 3 - 74 - ~ fJ ~ '~ <br />2. Operation name (n it, mine or site oame): Rio GhI U 5 !" r ?^ <br /> <br />3. Permitted acresee /pew or existine site): ~' q B ~ permitted acres <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees; <br />4.1 New Application <br />4.2 New Quarry Application <br />4.3 Milling Application (Non-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />SO • (0 3 acres <br />!00• (,off acres <br />51-$Y5:90 application fee <br />52:325':00 quarry application <br />53;tt)tTAO milling application <br />3+3599- amendment fee <br />~.3Q-`~GU i+:&}Sb0 conversion fee <br />Primsrv commoditie(s) to be mined: 71 ir7~ .Si9 n/l) ~~(~(_ <br />S.l incidental commoditie{s) to be mined: I . Ibs/fons/vr 2. / Ibs~fonsivr <br />3. ! Ibsrfonslvr 4. 1 Ibs~l'ons/vr 5. i Ibs/i'onslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~1) ~ /ylfFrEle1 /4L _ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: ~OnJ~ <br />