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TATE OF COLOI~DO <br />DIVISION OP MINERALS AND GEOtOGY ~ ~ ' <br />Department of Natural Resounxs ~ • <br />1313 Sherman 5[., Reom n 5 ~~ C O L O RA D O <br />Denver, Colorado eozo3 CONSTRUCTION MATERIAIS D t v t s E o N o r <br />Phone: (303) 8663567 '' ' ~ MIN & A L $ <br />FAx: t3o3) e32-aroe .REGULAR (112) OPERATION G E O L O G Y <br />RECLAMATIONPERMTCAPPLICATIONFORM ~.~ 0.ECLANA110MNINING <br />SAFETr•t CIENCE <br />- ~~ alll Owens <br />CHECK ONE: X There is a Ft7e Nmnber Atrcady Assigned to this Operation ~"M' <br />19 9 4 -.0 9 6 Greg E. Watcher <br />Permit # Ivi -_ _ _ (Please reference the fde number cutrently assigned to this operation) Ezecsrnve olrettur <br />_ New Applieetien (Rule 1.4.5) _ Amendment Application (Rule 1.10) Ronald w. cottony <br />?t Conversion Application (Rule 1.11) Dnri1on o'reC1O` <br />NaN21 Resource Trustee <br />pmt # h, .19 9 4- 0 9 6 -_ ~ovide for Amendments and Converalons of existing pemrits) <br />The application for a Coasttvction Materiels Regular 1 12 Operation Reclamation Pemdt contains three major parts: Q) the application foml; <br />(2) Exthibits A-S, Addendum i, any sections ofExhibit 6.5 (Geotecbnical Stability Extubit; and (3} tits application fen. When you subinityour . <br />application, be sore to include one (1) eorgplete siffied and notart?e~ IVORY ORIGINAL. and one (1) copy ofdte cotitpleted Ivory application <br />form, two (2) copies ofExhibits A-S, Addendum 1, appropriate sel~ons of 6.5 (Geotechrrical Stability Exhibit, and a check far the application <br />fee described tinder Section (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to 8 12" X 11" m 81/2" X <br />l4" s;2e. To expedite processing, please provide the information in the format and order described in this form <br />GENERAL OPERATION INFORMATION <br />Type or print cleaHy, in the space provided, ~h IntotTaatlon requested below. " <br />1. AoolicanUooeratororcomoaavname(nametobeERedonoermitl: High Plains Sand And Gravel, LLC <br />1.1 I'ypeoforganizatioa(corparation,partnership,etc.): Limited Liability Company <br />1.2 I.RS. Tax I.D. No. or Social Security Number <br />2. Operation name (nit, mine or site namel: <br />3. Permitted aceage fnew or e:latine eitel: <br />3.1 Chmge rtt acreage (+) <br />3.2 Total acreage in Permit area <br />RUSSELL GRAVEL PIT <br />b- <br />43 <br />49 <br />pe[mitted acres <br />4. Fees: <br />4,1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion m 112 operation (set by statute) <br />5. Primary mmmoditie(sl to be mined: Grave 1 <br />5.1 Inciderrtalcorrrmoditie(s)ID4emined: 1. n/a- Ibs/fons/yr <br />acres <br />acres <br />52.344.00 application fee <br />52.906.00 quarry application <br />$ 938.00 amendment f <br />52 344.00 conversion fee <br /> <br />3. / 1bsR'ons/x 4. ! ibs/Ionslvr 5. / !bs(tons/vr <br />i.2 Anticipated end use ofprimary cornmodiNe(s) to be mined: Road base <br />5.3 Anticipated end use of incidrntal commoditie(s) to be mined: n/a <br />Offioe of Office at Colorado <br />Mined land Reclamation Acnve and tnac[hre Mirles Geological Surv <br />z'd IbBE 699 OL6 .a~e39 'I1 4dlopuea dO5r40 40 91 1nC <br />