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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 8663567 CONSTRUCTION MATERUILS <br />FAX: (303) 832$106 REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CIfECK ONF.: There is a Fik Number Already Assigned to thEa Operation <br />Permit # M -_ _-_ (Please reference the file nrnrtber currently assigned to this operation) <br />New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) <br />_ Conversion Application (Rule 1. ] 1) <br />Permit # M -1977 _ 526 -_ (provide for Amepdmenta and Converoiopa of existing permits) <br />COLORADO <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />0.ECLANATION•NINING <br />LAiETT•ELIENCE <br />Bill Owens <br />Goverrwr <br />Russell George <br />Ezeaaive Director <br />Ronald W. Cottony <br />Division Director <br />Natural Rtsourtt Trustee <br />The application for a Construction Materials Reguiaz 112 0perationReclamation Permit contains throe majorparts: (I) the application form; <br />(2) Exhibits A-S, Addendum I ,any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />epplicetion, be sure to include one (I) col~le[e silmed and notarized ORIGINAL and one (1) copy ofthe completed application form, two (2) <br />copies of Exhibits A-S, Addendum 1, appropriate sections of6.5 (Geotechnical Stability Exhibit, and a check for the application fee described <br />undL•r Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1!2" X 11" or 8 ] /2" X 14"size. To <br />expExfite processing, please provide the information in the format and order described m [his form. <br />GENERAL OPERATION INFORMATION <br />Type or print tkarly, in the spate provided, ALL information requcated below. <br />I. Applitant/operator orrnmosnvname (name /b be used on permit): Albert FCei and SOnS, Inc. <br />1. ] Type of organization (corporation, partnership, etc.): COLDOratlOrl <br />2. OperaCEOn name (pit, mine or site parcel: WOthtng Plt (Pit 4) <br />3. Permkted aereatee (sew or eaiatintc akel: <br />3.1 Change in acreage (+) <br />Worthing Pit <br />3.2 Total acreage N Permit area <br />160.90 permitted acres <br />0.00 acres <br />160.90 acres <br />4. Fees: <br />4.1 New Application 16~.t911X~0 application fee <br />4.2 New Quarry Application $P~$~iX10 quarry application <br />4.4 Amendment Fce $1.938.00 amendment fee <br />45 Conversion [0 112 operation (set by statute) `) conversion fee <br />5. Primary tomroodkie(s1 to be mined: sand gravel shale <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/fonshT 2. / lbs/TonsAT <br />3. / Ibs(1'ons/vr 4. ! Ibslfons/vr 5. / 1bslTonshr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: raw cnnctruction materials, hackfiil material <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined land Reclamation Active and Inactive Mines Geological Survey <br />