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TATE OF <br />DNISION OF MINERAiS AND GEOLOGY <br />Department o(Na[ural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 DIVISION O F <br />Phone: (303) 866-3567 1~'~ I N E RA L S <br />FAX' (303) 832-8106 ~ & <br />GEOLOGY <br />CONSTRUCTION MATERIALS a E c t A M A n o N <br />MINING•SAFETY <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM Biil Owens <br />Governor <br />Greg E. Watcher <br />Executive Director <br />CHECK ONE: _ New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.1 icnael s. Long <br />Division Director <br />Conversion Application (Rule 1.11) <br />Permit # M - 20 -~- 0 21(provide for Amendments and Conversions of existing permits) <br />The application for a Construction Ivlaterials Regulaz 112 Operation Reclamation Permit contains three major pazts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the applicaflon fee. When you submit your <br />application, be sure to include one (1) complete sieved and notarized IVORY ORIGINAL and fots (4) copies of the completed Ivorv <br />application 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 Section (4) below. Exhibits should NOT be bound cr in a 3-ring binder; maps should be folded to 8 1/2" 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 cleazly, in the space provided, ALL information requested below. <br />AoplicanUooerator or comoany name (name to be used on oermitl: Ran Ch Land LLC <br />1.1 Type oforganizafion(corporafion,pazmership,etcJ: Ranch T,and LTC <br />1.2 I.R.S. Tax I.D. No. or Social Security Numbea: <br />Opetation name (nit, mine or site name): Ranch L Arid Rock Pit #2 <br />Permitted acreage (new or existing site): ?!}~_ permitted acres <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />Primary commoditie(s) to be mined: ,~rayal - <br />5.1 Incidental commoditie(s) to be mined: 1. Ibs/I'ons/vr <br />3. / lbs/Tons/vr 4. / lbs~i'ons/vr <br />690 acres <br />930 acres <br />$2.344.00 application fee <br />$2.906.00 quairy application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / lbs/I'ons/vr <br />5. / Ibs/Tons/vr <br />5.2 Anficipatedenduseofprimarycommodifie(s)tobemined: cOrist]"UCt10ri mateilal <br />5.3 Anticipated end use of incidental cortunodifie(s) to be mined: <br />