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<br />STATE OF COLORADO <br />Depardrrent of <br />GEOLOGY <br />i 313 SherlilanlS 7R®o~q~~ 1\ <br />Denver, Cblbt~do`803(f! T <br />Phone:-.(3031866-3567 ~ ~C 1 <br />F b ,_,I,_ CONSTRIICTIONMATERiAIS <br />~~~ <br />2 9 2003 <br />LIIVIITED 1MPAC1' (110) OPERA'~rS~P° °f Minerals and GeolocN <br />fOR SCANN/NI~CL~ATION PERMIT APPLICATION FORM <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAP ETY <br />gill Oweta <br />Governor <br />Greg E. Walther <br />CHECK ONE: ' ~ There is a File Number Already Assigned to this Operation Executive Director <br />Ronald W. Caaany <br />Permit # M O;~-~-~ (Please reference the fde number cu[Ieatly assigned to this operation) Acting Division Director <br />New Application (Rule 1.4.5) <br />Am~dment Application (Role 1.10) <br />Pewit # ~~~-,~ (pmvide far Amendments anti Conveniona of existing permits) <br />yvI- ~qs7- rata <br />Conversion Application (Rule 1.11) <br />The application for a Conshnction Materials Limited Impact (110) Operation Reclamation Petmi[ contains throe major pmts: (1) the <br />application fo®; (2) Exhibits A-I, Exhibit L, Adthendtmm 1, a~ sections ofExhmbi<' 6.5 aria Geotechnical Stability ExhibII, as required by the <br />Office, and outlined in Roles 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When you submit your application, be sure to <br />include one (I) complete siffiod. and notarrzod IVORY ORIGINAL and anti (1) copy of the cump6efed 1~ application f~, two (2) copies <br />of Exhibits A-J, Exhibit L, Adticedam 1, and appiopriate sections of 6.5 (Geotechnical Stability Exhibit), as regnffed, and a check for the <br />application fce tiescn'bed minder (4) below. Exhibits should NOT be bond or in a 3-ring binder; maps should be folded to 8 112" X 11" or <br />8 12" X 14" sim. To expedite processing, please provide the infommation in time format and order descnbed in this form. <br />GI~QERAL OPERATION INFORMATION <br />Type or <br />ha the space provided, AI I, mt'otmation descnbed below. <br />1. ADDltcantlooerator or comoanv name (name to be used oa nermitl: <br /> <br />fC <br />I.1 Type af'cargaslzeticm (corporation, partnership, ere.>: o esker o~ era R <br />1.2 I.RS. Tax ID No. or Social Secnrhy N®ber: 2.: ~ ~:3 - 7 oC '- <br />2. ODeratton name (pit, mine or site namel: <br />3. Permitted acreaee (new or existing sitel: <br />- - - - 3.I Chmge-m acrea8e (+} - - - - - - - - - - - - - - - - - - <br />3.2 Total Acreage in Permit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34-32.5-125(m): <br />4.2 Conversion Fce (from 1104 in 110 875.00 comeresioa fee (Role 1.11.2(2)) <br />5. Primary commoditie(s) w be mined: ~ ~ CJ~°t~ <br />_s~ permitted acres <br />- - - - - -~; 9--acres <br />9• acres <br />$1.094.00 application fee <br />$719.00 application fee >r _ <br />5.1 Incidentai commoditie(s) to be mined: 1. / Ibs/I'ons/vr 2. / Ibsl1'ons/vr 3. / ibs/Tons/vr <br />NOAI ~ <br />4. / _Ibs/Tons/vr 5. '/ Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Qu r ~v~ 1 i\1 Q ~ 14T~° t' I ~C ~-^ <br />Anticipated end use of incidental commoditie(s) to be mined: NON`° <br />