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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />~ <br />Department of Natural Resources <br />13735herman St., Room 215 RECEIVED ~ <br />Denver, Colorado 80203 ~~~~~ <br />Phone: (303) 866-3567 <br />FAX: (3031 8328106 JAN 2 4 2000 <br /> DEPARTMENT OF <br /> NATURAI <br /> Division of Minerals 8 Geology . <br />CONSTRUCTION MATERIALS ~S~~CES <br />REGULAR (112) OPERATION <br /> Roy Romer <br />RECLAMATION PERMIT APPLICATION FORM Governor <br /> lames S. Lochhead <br /> E.ecNive Director <br /> ^.tichael B. Long <br /> Division Director <br />CHECK ONE: New Application (Rule 1.4.5) / Aaeadneat Application (3ule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # ~ - }~' - 10 3 - _ (provide for Aaeadmeats and Conv~ssions of existing <br />permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-S, Addendum :., any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. W}ten you submit your <br />application, be sure to include one (1) complete signed and notarized IVORY OR7:GIiAL and four (9) <br />copies of the completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for t:he application fee <br />described under Section (9) below. Exhibits should NOT be bound or in a 3-ring binder; maps <br />should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide <br />the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL iafoisatioa requested belox. <br />1 <br /> 1.1 Type of organization (corporation, partnership, etc.): C9PJi~b ?1.t~Onf <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: ~~" (L~~-~'~ 2 <br />2. Operation acme (nit, mine or site name) : "T~.H•~• PtC vG~~atE Sov~Pt>= <br />3. Perai tted aoreaaQ laaw or ezistiao site): ~~ O _ permitted acres <br /> 3.1 Change in acreage (+) ) 3 ~ acres <br /> 3.2 Total acreage in Permit area ~-3) acres <br />9. Fees: <br /> 4.1 New Application '~ 51,875.00 application fee <br /> 9.2 New Quarry Application S2,325.00 quarry application <br /> 9.3 Milling Application (Non-DMO) 53,100.00 milling application <br /> 9.4 Amendment Fee 51.550.00 amendment fee <br /> 9.5 Conversion to 112 operation (set by statute) 51.875.(~~ conversion fee <br /> <br />5. <br />Pr+s~ f+RE, - <br />+v oamnoditie(s) to be mined: Q~Q'QhR <br /> S.1 Incidental commoditie(s) to be mined: 1. - lb:;/Tons/vr <br /> 2. / lbs/Tons/xr 3. / 16:;/Tons/vr <br /> 9. / lbs/Tons/vr 5. / lb:>/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: ~1.0`M A1'rsj4AVi ~ <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: ~QOSXOnf ~N'~Q.pl <br />