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<br />DIVISION OF MINERALS AND GEOLOGY <br />UPpdrlmenl nl Natural Resources <br />171 J Sherman SL. Room .1 S <br />Denver, Colorado BU207 <br />Phone. 13011 tlLL~35Gi <br />FAY:17(1 f1 tll]-tll(IL <br />'~~El~i~!'r <br />N = -~ <br />• <br />~T~ OF COLOIZA~O <br />CONSTRUCTION MATERIALS <br />-~~W LIMITED IMPACT(I10)OPERATION <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />Bdl Owens <br />Governor <br />_;,~_at~. c; !1.~!t2ta:e ~ G°0!r j'c RECLAMATION PERMIT APPLICATION FORM GeR E watcher <br />Emcuuve Dirmur <br />Michael B. Long <br />Dnhion Director <br />CHECK ONE: ~_ New Application (Rule 1.4) Conversion Appli(ation (Rule 1.1 I ) <br />Amendment Application (C.R.S. 34-32.5-110) <br />G *' <br />Permit # M ~~-_ I~~ (provide for Amendments and Conversions of existing permits) <br />The application for a Constnaxian Materials Limiud Impact (110) Operarion Reclamation Petmh contains three major pans: (1) the application form; <br />(2) Exhibits A-1, Exhibit 4 Addendum 1, arty sations ofExlubh 6S and Geauchnical Stability Exhibit, as required by dte Office, and outlined in Rules <br />6.1, 6.2, 6.3, 6.5, and 1.(i.2(lxb); and (3) dte application fee. When you submit your application, be sure to include one (1) complete sieved and <br />notarized fVORY ORIGQVAL and one (1) copy ofthe completed vo application form, two (2) copies of Exhibits A-J, Exhibit L, Addendum I, and <br />appropriau sections of65 (Geatechnical Stability Exhibit), as required, and a check for the application fce described under (4) below. Exhibits should <br />NOT be bound or in a 3-ring bolder, maps should be folded m 812" X 11" or B 12" X 14" siu. To expediu processing, please provide the information <br />in the format and order described in this form. ~~~ ~a~ <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the span provided, ALL information described below. <br />1. A-pplleant/ooeratororeomoaovnamefnametobeusedoeoermkl: EVAN L- MELBY. INC. <br />1.1 Type of organintion (corporazion, partnership, etc.): CORPORATION <br />1.2 I.R.S. Tax [D No. or Social Security Number: <br />2. Operation Dame foil mine or site namel: PIT 1 <br />3. Permitted aereaee (new or existing sitel: permitted acres <br />3.1 Change in acreage (+) 12 acres <br />Tonal Acreage in Permit Area _) 2 acres <br />4. Fees: <br />4.1 New Application: 875.00 application fee <br />Amendmrnt Fee (C.R.$. 34-32.5-125(11)): 575.00 application fee <br />4.2 Conversion Fee (from I I Od to I IO I875.00 conversion fee (Rule 1.11:2(2)) <br />5. Primary commaditiefsl to be mined: SAND <br />5.1 Incidental commodities s)to be mined: I. / Ibs~fons/vr 2. / Ibs~fons/vr 3._ ! Ibs/fons/vr <br />4. ! Ibs(I'onslvr 5. t Ibs/Z•onsrvr <br />5.2 Anticipated end ux of primary commoditie(s) to be mined: 2005 <br />5.3 Anticipated end use ofincidental commoditie(s) to be mined: <br />