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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman SL, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />RECF~~AEp <br />MAR 1 3 [002 <br />OiYiSion of Minerals and Geology <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SA FETY <br />Bill Owenz <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: _ New Applicaflon (Rule 1.4.5) R Amendment Application (Rule 1.1 ichael e. Long <br />Division Director <br />_ Conversion Application (Rule 1.11) <br />Permit # M - 79 _ 089 -_ (provide for Amendments and Conversions of existing permits) <br />The applicaflon for a Construction Materials Regulaz 112 Operation Reclamaflon Permit contains three major pazts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geo[echnical StabifityExhibit and (3) the applicaflon fee. When you submit your <br />application, be sure to include one (1) complete siened and notarized IVORY ORIGINAL and four (4) copies of the completed Ivorv <br />applicaflon form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the . <br />applicaflon fee described under Secflon (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 lY2" X 11" <br />or 8 1/2" X 14" size. To expedite processing, please provide 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 information requested below. <br />AoplicanUoperator or company name (name to be used on permit): Grand Junction Pipe $ Supply Co. <br />1.1 Type of organization (corporation, paztnership, etc.): Corp. <br />1.2 LR.S. Tax LD. No. or Social Security Number <br />2. <br />3. <br />Operation name (pit, mine or site name): <br />Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion [0 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Sand $ Grave 1 <br />5.1 Incidental commoditie(s) to be mined: 1. - lbs/Tons/vr <br />67. S permitted acres <br />47.4 acres <br />114.9 acres <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / lbs/I'ons/yr <br />3. / lbs/Tons/vr 4. / lbs/fons/vr 5. / lbsll'ons/vr <br />5.2 Anticipated end use ofprimazycommoditie(s)[obemined: Construction Material f, Concrete <br />5.3 Anflcipated end use of incidental commoditie(s) to be mined: <br />