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TATE OF COLORf~DO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FqX: (303)832-8106 <br />~% <br />APR 2 4 2002 <br />CONSTRUCTION MATERIALS <br />LIi IITED IMPACT (110) OPERATION <br /> <br />MAY 2 0 1002 <br />Division of Minerals and <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />DECLAMATION <br />MINING•SAFETY <br />Bill Owens <br />RECLAbIATION PERMIT APPLICATION FORM Governor <br />~CK ONE: New Application (Rule 1.4) <br />Creg E. Walther <br />Executive Director <br />Michael B. Long <br />Conversion Application (Rule 1~1°~on Do-ecror <br />% Amendment Application (C.R.S. 34-32.5-110) <br />Petmi[ # M -19 78 096_ (provide for Amendments and Conversions of existing permits) . <br />to application far a Constriction Materials Limited Impact (I 10) Operation Reclamation Permit contains three major parts: (1) the appIicaflon form; <br />Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical StabilityExhibit, as required by the Office, and outlined in Rules <br />1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one (1) ~mnlete sieved and <br />~tarized IVORY ORIGINAL and one (1) copy of the completed Ivarv application form, two (2) copies ofExlnbirs A-J, Exhibit L, Addendum 1, and <br />propriate secflons of 6.5 (Geo[echnical StabilityExhibit), as required, and a check for the application fee described under (4) below. Exhibits should <br />OT be bound or in a 3-ring binder, maps should be folded to 8 1/L" X 11" or 8 1/2" X 14"size. To expedite processing, pleaseprovide the informafion <br />the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />Anolicantlonerator or comnanv name (name to be used on permit): Fremont Countv Board of Commissioners <br />1.1 Type of organizafion (corporadon, paztnership, etc.): Government Agency <br />1.2 I.R.S. Tax ID No. or Social SectlrityNtunber: <br />Operation name (nit, mine or site name): Coaldale Pit -Dist ll3 <br />Permitted acrea¢e (new or existing site): 5 permitted acres <br />3.1 Change in acreage (+) 4.9 acres <br />Total Acreage in Permit Area 9.9 acres <br />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 110d [0 110 875.00 conversion fee (Rule 1.11.2(2)) <br />Primary commoditie(s) to be mined: Road Materials/Gravel ~C`. <br />5.1 Incidental commoditie(s) [o be mined: 1. 10, OQO ~fFJs~I'ons/vr) 2. / lbs/I'onshr 3. ~, / ~ ~•, lbs/I'ons/~r <br />4. / lbs/I'ons/vr 5. / lbs/Pons/vr ~ ~ ~ ; <br />v ,-. ~.._ e v, <br />5.2 Anticipated end use of primarycommodifie(s)tobemined: Road Materials/Gravel- <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />~ ~ ~~~~~ <br />N/A <br />~ ~ - a s~- a .~' : `~ <br />~~~ <br />