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ILE COPY <br />fOR SCANN/NG <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />RECEIVED <br />SEP 3 01004 <br />Division a(Minerals and Geolo~t <br />Pemit # M -19 _ 88 _093 (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) X Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Pemrit # M - i 9 _ 88 _ 093 (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Permit coatafirs three major parts: (I) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) conwlete signed and notarized ORIGINAL and one (1) copy of [he completed <br />application form, two (2) espies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or m a 3-ring binder, maps should be folded to <br />8 1/2" X 1 I" or 8 1!2" X 14" size. To expedite processing, please provide the information in [he format and order desenbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />I. AonticanUocerator or comnanv name (name to be used on oermitl: Fremont Paving & Redi Mix, Inc. <br />Ll Type of organization (corporation, partnership, etc.): Corporation <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. OceraNonname(oit.mineorsitenamel: Fremont Paving & Redi Mix Pit <br />3. Permitted acreage (new or existine sitel: 22.5 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit azea 22 .5 acres <br />4. Fees <br />4.1 New Applicaton $2 344.00 application fee <br />4.2 New Quarry Application $2.906.00 quarry application <br />4.4 Amendment Fee $1,938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Prim ary commoditie(s)tobemined: Sand Gravel <br />5.1 Incidental commoditie(s) to be mined: I. N/A - Ibs/Tons/vr 2. / Ibs/1'ons/yr <br /> 3. / lbs/'I'ons/vr 4. / Ibs/Tons/vr 5. / Ibs/I'ons/yr <br />5.2 Anticipated end use of primary commodi[ie(s)Wbemined: Construction aQ t;re>;ate <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br />