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STATE DIVISION OF MINERALS AND GEOLOGY ~EC~1\/ED Department of Natural Resources 1 J 13 Sherman Si., Room ? I S ~y 17 1999 Denvcr, Colorado 80?03 Phnnc: !3071 8G6-3567 FAX: (30.31 8J'-8106 ayjq~jQfl Gf NIIIl6f313 (~ ly III III'llllllllllll 999 COLORADO ` ,~ ~~ / ~/ /`/ ~ F CONSTRIICTION t9l~araT.g ~~ REf,'OLAR (112) OPERATION RECLAMATION PERDIIT APPLICATION FORM 3 Roy Rosner Governor Wmei 5. Lochhead Esecuu~e Gheror Michael 8. Long Division Director CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) X Conversion Application (Rule 1.11) Permit # ~-~1_- 197 -_ (provide for 7~so++r+.re..ta and Conversions of existing permits) The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; 12) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your application, be sure to include one (1) complete sinned and notarized IVORY ORIGINAL and four (9) copies of the completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) below. Exhibits should ~ be bound or in a 3-ring binder; maps should be folded to 8 1/2^ X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. GENERAL OPERATION INFORMATION ~ilT-~I Type or priest clearly, in the space provided, ~ ia£ormatioa requested below. eases----n~as~a-----sssa~~:a.-----~~ve=ev iesva=c--esv~ve==ea....eea~vsc===eeo~s=-=-e~a~:c 1. AtDOlicant/_o>Derator or eoapanv same !name to be used on permit): Hard Rock Paving and Redi-Mix, Inc. 1.1 Type of organization (corporation, partnership, etc.) : corporation 1.2 I.R.S. Tax I.D. No. or Social Security Number: 2. Operation name (pit, mine or site name): Main Pit 112 Permit 3. Permitted acreage (new or existinc site): ~•~_ permitted acres 3.1 Chanqe in acreage (+) acres 3.2 Total acreage in Permit area 4F..S~t acres 4. Fig: 4.1 New Application S1,875.00 application fee 4.2 New Quarry Application 52.325.00 quarry application 9.3 Milling Application (Non-DMO) 53.100.00 milling application 4.9 Amendment Fee amendmentlfee 9.5 Conversion to 112 operation (set by statute) 87 0 onversion fee 5. Pr+"t~r commoditie(s) to be mined: Sand Gravel ~ ~~ 5.1 Incidental commoditie(s) to be mined: 1. None - ~bs/Tons/vr ~, 2. / lbs/Tons/vr 3. / lbs/Tons/vr 9. / lbs/Tons/vr 5. / lbs/Ton /vr ~ 5.2 Anticipated end use of primary commoditie(s) to be mined: (~pnq~,r.t;.,n Anrrranatac 5.3 Anticipated end use of incidental commoditie(s) to be mined: .~ ; rn:. ~ .: _ .. .. - L ...act .