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TATE OF CCJLQRLADO <br />DIV1510N OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St, Room 215 <br />Denver, Coorado 80203 <br />Phone: 13031 8663567 <br />FAX: (303) 832-8106 <br />RECEIVED coLOR <br />~8 E)O g001 Ot V ESEON O F <br />U L L MINERALS <br />Division of Reclamatio G E O LO G Y <br />Mining and Safety RECLANAiiON•Ni NING <br />SARETY•SCfENCE <br />REGULAR (112d) DESIGNATED NININO OPERATION <br />BiR Or,em <br />RECLAMATION PERMIT Governor <br />APPLICATION FORM Russell George <br />Exeanive Director <br />Ronald W. Cattany <br />Division Dfnxtor <br />Natural Resource Trustee <br />CHECK ONE: New Application {Rule 1.4.5) ~,_ Amendment Application (Rule 1.10} <br />Conversion Application (Rule 1.11) <br />Permit No. M-~-Z - .~ Z (provide for amendments and conversions of <br />existing permits) <br />The application for a Regular (112d) Designated Mining Operation Reclamation Permit <br />contains three major parts: (1) the application form; (2) Exhibits A-T, Geotechnical <br />Stability Exhibit, the Emergency Response Plan, and Addendum 1, as required by the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, 6.4.19, 6.5, 8.0, and 1.6.2(1)(b); and, (3} <br />the application fee. when you submit your application, be sure to include one (1) si ed <br />and notarised Oray original and four (4) copies of the application form, five (5) copies <br />of Exhibits A-T, Rule 6.5 Geotechnical Stability Exhibit, the Emergency Response Plan, <br />Addendum 1, and a check for the appropriate application fee (described under Section (4) <br />on Page 2). Exhibits should not be bound or in a 3-ring binders; maps should be Folded to <br />e 35" X 11" or 835" X 14" size. To expedite processing, please provide the information in <br />the format and order described in this form. <br /> <br /> <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/operator or company name (name to be used on permit): <br />~/~~t~- /itaLY~3c7£rltra..t L'cwc/~a~l~' <br />1.1 Type of organization (corporation, partnership, etc.) :.e~C't~l~~Q~•'-~o~`/ <br />1.2 I.R.S. Tax ID No. or Social security Number: /3 - ral(~2(0 <br />2. Operation name (pit, mine or site name): ~fF~-~~4,~~0~( /'2r^~E <br />3. Permitted acreage: (new or existing site) ~T C=~_ acres <br />3.1 Change in acreage {+) ~ ~E~ acres ~ <br />3.2 Total acreage in Permit area ~~ ~ U<~ acres <br />/~~t ~ tr}µQP /~// <br />.5r Cf7G+t. ~cle~ ~~SS Z_O c~GitS C('1Fe~~. <br />Office of Office of Colorado <br />~. Mined Land Reclamation Active and Inactive Mines Geologies! Survey <br />