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TATE OF ~C.~LORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depamnento(NaturaiResources ~ ~~~ IJ ,10D9 <br />j 313 Sherman St., Room 215 tt~ D I V I S I O N O F <br />Denver, cAierade ao2o3 MINERAL S <br />Phone: (303) 866.3567 division of Minerals & Geo10 <br />FAX: (303) 832.8106 ~ - & ' <br />GEOLOGY <br />CONSTRUCTION MATF.RTAiR ~ MININGMSAFETY <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM eat ovens <br />Govcmtu <br />' ~ Geg f. Walther <br />Fxewave Director <br />CHECK ONJ3: ,_ New Application (Rule 1.45) ~_ Amendment Application (Rule 1.10~i~~i e. to^s <br />Nislon DIreMr <br />Convoraion Application (Rule ].1 ]) <br />Permit# M - 76 -020 -~ (provide for Amendments and Conversions of wdsting ptzmits) <br />The application for a Construction IvlattT+ala Regular 112 Operation Reclamation Pemrit contains three major pans: (1) the application form; <br />(2y Exhibits AS, Addendl~ 1, any etxtioas of Bxhibit 6.5 (Geotechnical StabilityExbibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sicned and notarized IVORY ORIGINAL sad fom (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6S (Oeotochmcal StabiliryExhihit. and a clteckfor the . <br />]rcaCon fee desasbed tinder Sectioa (4) blow. Exhibits should 1 O'~ tie bawd or is a 3-ring biadrr; maps should befolded to 8 12" X 11" <br />or 8 1/l" X 14" size. To expediteproceseing, please provide the information in the format and ortlea desta'bed in this form. <br />GENBftAt, OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />Oldcastle SW Group, Inc. <br />1, Aonlicant/ooerstor or wmoany name (name to be used on Dermitl: Four Corners Materials " <br />1.1 Type oforgattization (corporation,partneaship,etc.): Crirporatiori """• <br />12 I.R.S. Tax I.D. No. or Social SecurityNnmber: 84-0449536 <br />2, O~er ation,~tame (nit mine or site Hamel: Thomas Pit <br />3. Perm itted arsea¢e (new or esdstlne site); 29 . B ptxmitted acres <br /> 3.1 Cbangeinacreage{+) 10.98 sores ' <br /> 32 Totala¢eageinPermitarea 40.76 acres <br />4. Foes: , <br /> 4,1 NcwApplication _52.344.00 application fee <br /> 42 New Quarry Application $2.906.00 quarry application <br /> 4.4 Amendment Pee $1.938.00 an>endtnentfee <br /> 4.5 Conversion to 212 operation (set by statute) _ $2344.00 conversion fee <br />5, prim ary commod[He(sl to be mined: 'Gravel . <br /> 5.1 Incidental commoditie(s) to be mined: 1. lbs /Toas/vr 2. / Ibs/I'ons/vr <br /> 3._ / lbs/I'ons/g 4. / ]bs/ I'ons/yf 5. / lbs/Tons/vr <br /> 5.2 Antiapatedonduseofprimarycommoditie(s)tobemined: Agg reeate for concrete and road gravel <br /> .3 Anticipated end use of incidental commoditie(s) to be Wined: <br />