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l.n-o~ <br />STATE OF COLORADO <br /> <br />./DIVISION OF MINERALS AND GEOLOGY <br />f N <br />l R RECEIVED <br />atura <br />esources <br />Department o <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />/~B' 9 2~ <br />Phone: (303) 866-3567 V <br />FAX: (303) 832-8106 <br />Division of Minerals and Geoloyl+ <br /> CONSTRUCTION MATERLILS <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />R EC lA MATION <br />MINING•SA FETY <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM Bill Owens <br />CHECK ONE: „_ New Application (Rule 1.4.5) <br />_ Conversion Application (Rule 1.71) <br />Governor <br />Greg E. Walther <br />Executive Director <br />/- X Amendment Application (Rule 1.1f~ ichael B. Lang <br />Division Oirettor <br />/ Permit # M - 76 -020 -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construcfion Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (1) the applicafion form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exiribi[ 6.5 (Geo[echnical Stability Exhibit; and (3}the application fee. When you submit your <br />application, be sure to include one (1) complete si¢ned and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate secfions of 6.5 (Geotechnical Stability Erchibit, and a check for the <br />applicaton fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11 " <br />or 8 lYl" X 14" size. To expedite processing, please provide the informafion in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />~1. <br />2. <br />3. <br />4. <br />5 <br />Oldcastle SW Group, inc. ll1iA <br />Aaalicant/ooerator or comoany name (name to be used on oermitl: Four Corners Materials <br />1.1 Type oforganizafion(corporation,partnership,etc.): Corporation <br />1.2 LR.S. Tax LD. No. or Social SecuriryNumber: 84-0449536 <br />Operation name (nit. mine or site name): <br />Permitted acrease (new or existing sitel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />Fees; <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendrent Fee <br />4.5 Conversion to 112 operafion (set by statute) <br />Primary commoditie(s) to be mined: Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. - lbs/fons/vr <br />3. / Ibs/I'ons/vr 4. / lbs/'I'ons/Kr <br />29.8 permitted acres <br />10.98 acres <br />40.78 acres <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / Ibs/Tons/vr <br />5. / Ibs/I'ons/vr <br />5.2 Anticipated end use ofprimazycommoditie(s)tobemined: Aggregate for concrete and road gravel <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />