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iii iiiiiiiiuiuiii . . tnAR 13 '.390 REGULAR (112) PERMIT ~pNG APPLICATION FORM MINED ,,~t.,,~ This form contains two major parts: (1) General Operation Information and f2) Exhibits A-P, When you submit your application, be sure to include four signed copir~s of the General Operation Information, four copies of Exhibits A-P, and ask for the application fee described under (4) below. To expedite processing, please 4rrovide the information in the format and order described in this form. GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/Operator Name: Holnam Inc. 2. Operation Name (Pit; mine or site name): slab Canyon Limestone Qu~irxy Pernut No. - 3. Application type: Regular (112) Permit Operation. 4. Application Fee for Permitted Acreage* pe~nnitted acres. (E50.00 + S15.00/acre, 1st. 50 acres; (10.00/acre, 2nd. 50 acres; 55.00/acre, 3rd. 50 acres; 51.00/acre, any additional acreage; maximum fee of 52,000.00).* Note permitted acreage and application fee and attach a check for this amount when you file. apG~lication~fee. 5, Substance(s) to be mined (e.g., gold/silver/gravel): 6. Owners(s) of Substance to be Mined (check applicable box(s)): _ Private _ State _ Federal _ Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): _ Private _ State _ Federal _ Indian 8. Type of Mining Operation (check applicable box(s)): _ Surface _ Underground ` ]:n-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: PRINCIPLE c ec one 6th (Colorado) TOWNSHIP (write number and check direction): T RANGE (write number and check direction): R SECTION (write number): S QUARTER SECTION (check one): N1~ QUARTER/QUARTER SECTION (check one): _ NE GENERAL DESCRIPTION: (miles and direction from nearest town and approximate elevation) 10th (New Ftexico) Ute _ Nortir South East ~ West _ NW SE SW NW - SE - SW * If the operator is a unit of State or county government, an application ~`ee is not required. A fraction of an acre must be counted as one acre for fee calcul;rtion.