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STATE OF <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />2~~5 CC1 -l P <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone:D03)8663567 CONSTRUCTIONMATBRrsrc LA P(.~3 <br />FAX: (303) 832-0106 REGULAR (112) OPERATION CLEr2it^~ <br />,,;- <br />RECLAMATION PERMTT APPLICATION FORM <br />CHECK ONE: v~ There V a Fik N[unber Already Aaslgned to this Operation <br />Permit # M - g 2 .~__ ' .(please reference the file number currently assigned to this operation) <br />_ Nen Application (Ittile 1.4.5) _ Amendment Application (Rule 1.10) <br />Copveraion Application (Rule 1.1 I) <br />Permit # _ vl - ~2 _ OrjQ __ (provide far Amendments and Convenlona of e7dsting pemuts) <br />OrORADO <br />( V I S I O N O F <br />t~N_)sRALS <br />=DOLOGY <br />C I.ANATION•NI NIN ri <br />fAi[TT•f CIEN C! <br />Bill Owens <br />Govenar <br />Russell George <br />ExeMive Director <br />Ronald W. Gttany <br />Division Director <br />Nazunl Resource Trustee <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains throe major parts: (I) the application form; <br />(2) Exlbits A-S, Addendum 1, Bay sections of Exhibit 6.5 (GeotechpiExil Stability Exhibit; and (3) the application fee. When you subarityotlr <br />application, be sure to include e~ (1) complete slimed alsd notarized ORIGINAL and one (1) copy of the completed applicationfixm,two (2) <br />copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechaical Stability Exhibit, and a check for the application fee described <br />un~r Section (4) below. Exhibits should RIOT be bound or in a 3-ring binder; maps should be folded to 8 1 /2" X 1 I" or 8112"X 14"size. To <br />expedite processing, please provide the information in the format and order desen'bed in this form <br /> GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, AI.L hrfotmation requested below. <br />1. ~ip llcant/ocerator or rompanv name (name to be Deed on cei7lrit): L B G Q LLG <br /> 1.1 Type of organizati~(corporation,parmership,ete.): I-iMt~e~ Liabili~-~/ Com ~an~! <br />2. Ope ration name (oil. mine or site name): l q 1'1 r3. G 1 p Y I -f' <br />3. Permkted aereatre (pair or erlistine aitel: °J • 9 permitted acres <br /> 3.1 Change in acreage (+) S~ • ~ acres <br /> 3.2 Total acreage in Permit area g0 sores <br />4. ~; <br /> 4.1 New Application 52344.00 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. Primary commoditie(s) to be mined: 5 ar ~ 4j [~~`/e <br /> 5.1 Incidental commoditie(s) to be mined: 1. lbs/fons/Xr 2. / ]bs/Tonslvr <br /> 3. / ]bs/7'oasWr 4. / Ibs/To»s/yr 5. / Ibs/Tonslvr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: <br /> 5.3 Anticipated end use of incidental coltunoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Minrc ~'--'--'--' °~~-~-~~ <br />