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l - I ~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />~P~1h~o.'n~/e: 13031 866-35.67 <br />f ei~l <br />RECEIVED <br />CONSTRUCTION MATERIALS / OCT ~ B <br />DIVI51 <br />MINERALS <br /> <br />®~ ~~~ - a~®~ LIMITED IIVIPACT (110) OPERATION Division of Minerals and Geology <br />N CLAMATION PERMTT APPLICATION FORM <br />CHECK ONE: Y There is a File Number Already Assigned to this Operation <br />GEOLOGY <br />ft ECLA MATION <br />HINING•SAFETY <br />8111 Owens <br />Governor <br />Greg E. watcher <br />Executive Director <br />Michael B. Long <br />Permit # M - t~ _ 90 -O~~ (Please inference the file number currently assigned to this opetatio¢) Division Director <br />New Applicatio¢ (Rule 1.4.5) <br />/ Amendment Application (Role I.10) <br />Conversion Application (Rule ~ ) <br />Permit # M - r9 - ojo -o~~ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit I., Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); mmd (3) dte application fee. When yon submit yon application, be sure to <br />include one (1) complete signed and notar¢ed IVORY ORIGINAL mmd we (1) copy of the completed h~ application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Atdendum 1, and appropriate sections of 6.5 (Geoteclmical Stability Exhibit), as required, and a check for the <br />applioatio¢ fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1!2" X I1" or <br />8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace providedr ALL information described below. <br />I. A¢nlicantlo¢erator or comna¢v name (name to be used on Prrmit): <br />~iLEMoIV"r Co yt-aT'~ f <br />1.1 Type of organization (corporation, partnershrp, etc.): ~ VT• r-\rr~-NC..,~ <br />1.2 I.RS. Tax ID No. or Social Security Number: 2.: ~} - (o - oo©- ~~ <br />2. O¢eratio¢ name (nit, mine or situ namel: Q~ r+ls P11 P-~ ~~~K PST <br />3. Permitted acreage (new or existing sitel: ~•~ permitted acres <br />3.1 Change in acreage (+) 3.~F acres <br />Total Acreage m Permit Area ~ • 1 acres <br />4. Fees: <br />4.1 New Application: $1.094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): $719.00 application fee <br />4.2 Conversion Fee (from I lOd to 110 8$ ~s.oo conversion fee (Role 1.11.2(2)) <br />5. Primary rnmmtrditie(sl to be mined: QpOafl ~"tEt- <br />5.1 Incidental commro~d~itie(s) to be mined: 1.3oQ' ~o¢s~r 2. / ibs/fons/vr 3. / 1bs/To¢s/vr <br />RtP r.rYP 4. 1 IbslfovsJvr 5. ! IbslTons)vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~ns.D M /iT50.~A1 c. - . <br />Anticipated e¢d use of incide¢tal commoditie(s) to be mined: 'SOS\Or1 ~oN-t-ppL ~~g+r•~t~ QpAp ~p,sy, <br />