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~~ .. „~~~ATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY - <br />DepartmentofNaturalResources I O~ ~f /~/~.f~i~~ <br />1373 Sherman St., Room 275 J4H,/!/ RECE~~/E® <br />Denver, Colorado 80203 D i v i 5 t O N O F <br />Phone: (303) 866-3567 g~t1V1 I ICI E R:~ L $ <br />FAX: (303) 832-8106 - ~ APR 1 ~ 2DUL & <br />GEOLOGY <br />- CONSTRUCTION MATERIALS a E c t n n a r i o N <br />- Division of Minerals and Geology niNinlG•snFtrr <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: _ New Application (Rule 1.4.5) x Amendment Application (Rule 1.1 Ichaet e. Long <br />Division Director <br />_ Conversion Application (Rule 1.11) <br />Permit # M - 86 _ 159 __ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Ivlaterials Regular 112 Operafion Reclamation Permit contains three major pazts: (1) the applicafion form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) [he application fee. When yuu submit your <br />applicafion, be sure to include one (1) complete siened and notarized IVORY ORIGINAL and four (4) copies of the completed Ivorv <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sectors of 6.5 (Geotechnical Stability Exhibit, and a checkfor the <br />application fee described under Secflon (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 1 I" <br />or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in [his form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. AaplicanUoperator or company name (name to be used on permit): Lafarge West, Inc. <br />1.1 Type of organizafion (corporation, paztnership, etc.): corporation <br />1.2 I.R.S. Tax I.D. No. or Social SecurityNumber: <br />2. Operation name (nit, mine or site Hamel: Courtner Pit - Amendment <br />3. Permitted acreage (new or existing site): 259 permitted acres <br />3.1 Change in acreage (+) 0 acres <br />3,2 Total acreage in Permit area 259 acres <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Applicaflon <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primate commoditie(s) to be mined: Sand Gravel <br />5.1 Incidental commoditie(s) tD be mined: 1. n~a - Ibs/Tons/vr <br />3. / lbslpons/yr 4. / 1bs/I'ons/vr <br />5.2 Anticipated end use of primazy commoditie(s) to be mined: _ <br />5.3 Anticipated end use of incidental commoditie(s) [o be mined: <br />Fill <br />$2.344.00 application fee <br />$2.906.00 quazry application <br />$1.938 00 amendment fee <br />$2.344 00 conversion fee <br />2. / Ibs/I'ons/vr <br />5. / lbs/Tons/vr <br />