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TATE OF COLORADO <br />DIVISION Of MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />~~ <br />DIVISION O F <br />MINERALS <br />&. <br />GEOLOGY <br />RECLAMATION <br />MI NING•SAFETYI <br />RECLAMATION PERMTT APPLICATION FORM em Ovrens <br />Governor <br />Greg E. Walther <br />Execmive Director <br />CHECK ONE: _ New Application (Rule 1.4.5) x Amendment Application (Rule I.1 ichael 8. Long <br />~ivision Director <br />Conversion Application (Rule 1.11) <br />Permit # M - 83 - ~ lb - i (provide for Amendments and Conversions of existing permits) <br />The application for a Conswction Ivlaterials Regulaz 112 Opuation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit and (3} the application fee. V/hen you submit your <br />application, be sure to include one (1) complete si¢ned and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit and a check for the <br />application fee described undo Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br />or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and ordu described in this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. Anplicantlooerator or company name (name to be used on permit): dl's SnF~(Q X12$ iVYtlXStl~/,Sr1L <br />i <br />1.1 Type of organization (corporation, partnuship, etc.): T a~lofl <br />1.2 LR.S. Tax LD. No. or Social Security Number: Tn,c =. D Flo , ~ -1I 47464 <br />2. Operation name (pit, mine or site name); C.JD26Y M I RIRQ }~- .z713rGe <br />3. Permitted acrea¢e (new or existine sitel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Convesion to 112 opuation (su by statute) <br />5. Primary commaditie(sl to be mined: Saf+ Q CtYONG~ . <br />5.1 Incidental commoditie(s) to be mined: 1. N A. - Ibs/I'ons/yr <br />52.29 permitted acres <br />15 , 20 acres <br />h7 ~ acres <br />X2.344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / lbsll'ons/vr <br />3. / lbs/Tons/y3 4. / lbs/I'ons/vr 5. / lbs/I'ons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~.GYt~4t"~LCr~ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: ~p. <br />