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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depanmmt of Natural Resources <br />1313 Sherman St., Room 21 S <br />Denver, Colorado 80203 <br />Phone: (3031866-3567 <br />FAX: (3031832-8106 <br />wNSrlLUCrION IIdATEh31ALs <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There k s File N®ber Already Asalgned to thta Operation <br />Ptsmit # M '_; _-Y (Please reference the file number currently assigned to this operation) <br />New Application (Rak 1.4.5) <br />Conversion Application (Role 1.11) <br />Amendment Application (Rule 1.10) <br />Permit # ,~vf _-~-~_-D~ (provide for Am~dmeata eml Converslona of existing pits) <br />GEOLOGY <br />RECIA NATION <br />MINING•SAFETY <br />DIVISION OF <br />MINERALS <br />Bitl Owens <br />Governor <br />Greg E. Watcher <br />Executive Director <br />Ronald W. Caaany <br />Atting Division Director <br />The application for a Construction 1lrfatctials ltegalar 112 Operation ReclamationPetmi[ contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendom 1, aay aaaRions of ExlnbB 6S (Geotechnical Stability Exhibit; and (3) ~e application fee. When you submit your <br />application, be sore to include one (l) cam~lde si>mad and notarirad IVORY ORIGINAL and one (1) copy of the wmplefa=d I~ application <br />form, two (2) copies of I'sxhrbits A-S, Addendum 1, appropriate sections of 6.5 (Geotwlmical Stability Fxhrbit, and a check for the application <br />fee described antler Section (4) below. Exhibits slraald NOT be bomrd ar m a 3-ring binder; maps sheald be folded m 812" X ] 1" or 81/2" <br />X 14" size. To expedite processing, please provide the information im rite forms[ and order described in this form. <br />(INERAL OPERATION INFORMATION <br />Type or print ckady, in the space provided, ALL information requested below. <br />1. Applicant/otrerator or comuanv name (name to be used on nermitl: ~i~,,'i~,~~ ~ y. (.n r . v~ ~~_ <br />I.l Type oforganization(oerparation,Partoolship>etc.): C, ai,,,.,.,~~t <br />I <br />1.2 I.RS. Tax I.D. No. ar Social Security Number; ~(~f - (" GCICI `~ I <br />y,~t <br />2. Operation name fnk> mine or site namd: 1 V I G~-. [v 1 ~, y v~ ~i-rn./ r ~ ~ , ~- <br />3. Permitted acreage thew or e>:istine site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Foes: <br />4.1 New Applicslirm <br />4.2 New QnaTry Application <br />a.a Amendment Fee <br />a.S Conversion to 112 operation (set by statute) <br />i. Primary rnmmoditie(sl to be mined: / e 1 'r F <br />5.1 Incidental commoditie(s)tobe.mined: l.(rrL.Jel -t-bit»~~ Ibs/Tonslxr <br />3. / IbsR'anslvr 4. / lbs/fons/vr <br />Q r ! permitted acres <br />~ > U acres <br />~r9 , q acres <br />52344.0(1 application fee <br />52.906.00 quarry application <br />S1.938.00 amendmearfee <br />S23aa.00 conversion fee <br />2. ~:f ~ / ~~aaulbs/I'ons/~ <br />5. / lbs/Tons/vr <br />S.2 Anticipated end use of primary commoditie(s) to be mined: fir' J(•~ <br />5.3 Anticipated end osc of incidental commodite(s) to be mined: <br />