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STATE OF LOLOF ALSO <br /> DIVISION OF MINERALS AND GEOLOGY <br /> Department ofNatural Resources - _ - PFW7� <br /> rm 7 313 Sherman <br /> St., Room 215 - <br /> Denier,Colorado 80203 <br /> Phone:(303)866-3567 C <br /> FAX:(303)832-8106 <br /> DEPARTMENT OF <br /> NATURAI. <br /> CONSTRUCTION MATERIALS RESOURCES <br /> REGULAR OPERATION (112) <br /> ROy Romer <br /> RECLAMTION PERMIT APPLICATION FORM coremor <br /> lames 5.Lochhe.1 <br /> 4 (/�/� Uecuriw Director <br /> /1 Michael B.Long <br /> OMS=Director <br /> 3ECR ONE: New Application (Rule 1.4.5) X Amendment Application (Rule 1.10) <br /> Conversion Application (Rule 1.11) <br /> Permit # !1 81 - 309 (provide for Amendments and Conversions of <br /> existing permits) <br /> 'he application for a Regular 112 Operation Reclamation Permit contains three major parts: (1) <br /> .he application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical <br /> ;tability Exhibit; and (3) the application fee. When you submit your application, be sure to <br /> include one (1) complete sicrned and notarized IVORY ORIGINAL and four (4) copies of the completed <br /> .vory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 <br /> Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) <br /> )elow. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br /> )r 8 1/2" X 14" size. To expedite processing, please provide the information in the format and <br /> )rder described in this form. <br /> GENERAL OPERATION INFORMATION "' �1S!�•'� <br /> Type or print clearly in the space provided the information requested below. <br /> 1. Applicant/operator or company name (name to be used on permit) : <br /> Western Mobile, Boulder <br /> 1.1 Type of organization (corporation, partnership, etc. ) : corporation <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: ec/-l//6/gn <br /> 2. Operation name (pit, mine or site name) : Deepe Pit <br /> 3. Permitted acreage (new or existing site) 195 permitted acres <br /> 3.1 Change in acreage (+ or -) acres <br /> 3.2 Total acreage in Permit area 195 acres <br /> 4. Fees: <br /> 4.1 New Application $1,875.00 application fee <br /> 4.2 New Quarry Application $2,325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) $3,100.00 milling application <br /> 4.4 Amendment Fee $1,400.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) $1,875.00 conversion fee <br /> 5. Primary commodities) to be mined: NA <br /> 5.1 Incidental commodities) to be mined: 1. NA - lbs/Tons/yr <br /> 2, / lbs/Tons/vr 3. / lbs/Tons/yr <br /> 4, / lbs/Tons/vr 5. / lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: PIA <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: NA <br />