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~~+ ~ J <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY ~TtCC <br />Department of Natural Resources ~~~ <br />1313 Sherman St, Room 215 SFrp F~ <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS ~'%8•n.` ~,~ ~ GJ <br />PI~~ e~®PY ,° z ~ <br />E 3 REGULAR (112) OPERATION ~r° <br />RECLAMATION PERMIT APPLICATION FORM / aid%$,~4,CO <br />fOR SCANN/NG ~ %~~ <br />CI~.CK ONE: _~ There is a File Number Alrcadv Assigned to this Operafion <br />COLORADO <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />0.ECLAMATION•MINING <br />SAf ETY•SCIFNCE <br />Bill Owens <br />Governor <br />/ Greg E. Walther <br />Permit # M - gs -~-_ (Please reference the file number currently assigned to this operation) Executive Director <br />_ New Application (Rule 1.4.5) X Amendment Application (Rule 1.10) Ronald W. Cattany <br />Conversion Application (Rtile l . 11) Division Director <br />Natural Resource Trustee <br />Permit # M -~_-~±~g-_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major parts (1) the application form; <br />(2) Exhibits A-S, Addendum 1, an}'sections ofExhibit 65 (Geotechnical Stability Exhibit; and (3) [he application fee. When }'ou submityotu <br />application, be sure to include one (1) complete simed and notarized IV ORY ORIGINAL and one (1) copy ofthe completed Ivory application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for [he application <br />fee described under Section (4) below. Exhibits should NOT be bound or m a 3-ring binder, maps should be folded to 8 1 /2" X 11" or 8112" X <br />14" size. 1'o expedite processing, please provide the information uI the foanat and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print ckar{y, in the space provided, ALL information requested below. <br />I. A~oOcantiooerator or rnmoanv name (name to be used on cermipt): D UCOAL.ttd~ BvSl.t~-z' Tieusr <br />1.1 Type of organization (corporation, partnership, etc. ): ~ ! ~ US <br />1.2 I.R.S. Tax I.D. No. or Social SectuiTy Number: _ ~ `~ - L 2 6 gj 3 9 9 <br />2. ODeration Dame (oit, mine or site name): /tl"M1'tA r ~~~~ <br />3. Permitted acresee (new or eldstina aite): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Perrtut area <br />4. Fees: <br />4. i New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />permitted acres <br />acres <br />.,2 /6 . ~ acres <br />$2344.00 application fee <br />$2906.00 quarry application <br />$1.938.00 amendment fee <br />$2344.00 conversion fee <br />5. Primary commoditie(s) to be mined: 'OLD f $~ r0 kRUf_!.. <br />5. ] Incidental commoditie(s) to be mined: I. Ibslfonshr 2. / Ibs/Tonslvr <br />3. / ]bs/Tons/vr 4. / ]bs/I'ons/tr 5. / lbslfonshT <br />5.2 Anticipated end use of primary commoditie(s) to be mined: _~91+b YD QQECIO[9$ 4£IAIS Mr4RKE'T <br />5.3 Anticipated end use of incidental c;ommoditie(s) [o be mined: ~~~ } ~~ ~ ~~ B~~r <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />