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STATE OF COLORADO <br />a <br />DIVISION OF MINERALS AND GEOLOGY <br />Departmen d Na1ud Resauces ~ , <br />13135hemun sL, Room 215 ~ ~~ -' OOL(J RAD'O <br />Denver, Cot«ado 80203 D:visiu,r c. ~. M 1 N E R <br />Phone: Doi) 8W3567 CONSTRUCTION MATERIALS 11i1nt,:g -'q~ ~,,,,-- <br />FA%: (303) 832-0106 REGGLAR (172) OPERATION ' GEOLOGY' <br />RECLAMATION PERMIT APPLICATION FORM ff f,"INYISOCIfM'CfaC <br />8111 Owens <br />Gosemor <br />C[tfiC'K ONC: __ There i+ a Fik Number Already AaiReed to Ibis Opentbn R,arrll eeorae <br />Permit # M -_ _ _ (Please reference the file number currently es-signed to this opcration) E'°c"rive ol,eaor <br />Ronald W. Gmny <br />New Application (Rule 14.5) Amendment Applicatirm (Rule I. ]0) o;v;ad, a,~ <br />_ Canventon Application (Rule L l l) tJamN Resource rrasree <br />Permit # M - Zfb~ (~1'S- (pnnide for Ameodmrnts and Converaioos of existing permits) <br />The application Cor a Construction ~tateriaLs Regular 112 Operation ReJamation Yermit «mtains tha•e major parU: (1) the application foml', <br />(2) Exhibits A-S, Addendtan 1, any se«ions of Exhibit 6.5 ((ieutechnical Stability E?cltibit; and (3) dte application fce. When you submit yxwr <br />application, be sure to include one (1) wmpiete simted and rrotari7~d ORIGINAL and one (I) copy of the completed application form, two (2) <br />copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a checi; for the application fee described <br />under Section (4) below. F,xhibils should NOT be hound or N a 3-ring binder, maps should be folded to R 1!2" X 11" or R I2" X 14" site. To <br />exp~i[c processing, pleasu provide the information in the format and order described in this torm. <br />GENERAL OPERA'170N INFORMATION <br />Type or print ckarly. in the space provided, A L fuformatioe requested bebw. <br />I . AoolkanUocentnr or como+mv name (name to be used o0 oermitllI: ~ 1r2YP~ LLG <br />1.1 Tvpe of organization (corporation, parrtership, e[c.): Lr ryt r tGd L1 2 6 1 I r •~.~Lo r/f'~2~ <br />2. Dj)ention name(oit.mine or af4 Dame): ~OCJL DIXA '~~ 1 <br />3. Permitted aereaae (rcew or ezbtirre site): <br />3. I Change in acreage (+) <br />3.2 7'ntal acreage in Permit area <br />4. Fees: <br />4.1 New Apphcatifm <br />4.2 New Quam Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by slamte) <br />? ~ ~ • ~ permitted auc~ <br />1 3 . 3 acres <br />2 z~. 2 sues <br />$2.344.00 application fce <br />52-906,00 yuarry• application <br />$1.93R.(10 amendment fec <br />$2344.0(1 convesiw tee <br />i. Primxrt kammadkiefs)to be mined: 52r~ p/TN~~ S-~nL~ <br />5.1 Infideutal commoditie(s)1o he mined: L ~TIbslfonshr 2. / Ibs/1'unshr <br />3. / lbs/1'onJrr 4. / Ihs/1'ons/er i. / lbs/tonshr <br />5 2 Anticipated rnd use of primary- commoditie(s) to be mined: q P~vy Pi/y ~ f road eovr s-I-re.t [-•~-to n <br />i <br />5.3 Anticipated rnd ace of incidental commoditie(s) to be mined: N /ll <br />Offrca of Office of Cobndo <br />Mined land Reclamation Alive and Inatlive Mures Geological survey <br />