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ii iiiiiiiiiiiii iii • <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />131 }Sherman St.. Room 215 RECEIVED <br />Denver, Colorado 80203 D I v t 5 l o N O! <br />Phone: 1303) 866-3567 CONSTRUCTION MATERIALS MINERAL 5 <br />FA%: 13031 8328106 ~~ REGULAR (112) OPERATION DEC 0 7 2001 & <br />~'O RECLAMATION PERMIT APPLICATION FORM a EE O n O I a nYi <br />~M ~(~~ Division of Minerals andGeplogy MINtNG•sAFErY <br />\~~ <br />CI~CK ONE: Yes There is a File Number Already Assigned to this Operation <br />Permit # M - 83 _ .~ 067 (please reference [he fde number cturentty assigned to [his operation) <br />New Application (Rule 1.4.5) <br />Brll Owens <br />Governor <br />Greg E. Walther <br />Execmive Director <br />x MichaelB Lang <br />Amendment Application (Rule I.IO) o~e~sron Director <br />Conversion Application (Rule 1.11) <br />Pertni[ # M - 83 _ !~' - 0~ 77 (provide for Amendments and Conversions of existing pemtits) <br />The appbcation for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the appbcaion farm; <br />(2) Exhtbits A-S, Addwdum 1, any sections of Exhibit 6.5 (Geotecimical Stability Exhrbit and (3) the apphcation fee. 1Vhea you submit your <br />application, be sure to include oae (1) complete si®ed and notarized NORY ORIGINAL and four (4) copies of the completed Ivorv <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stabibn~ Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be botmd or ip a 3-ring binder, maps should be folded to <br />8 1/2" X 11" or 8 I/2" X l4" 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 apace provided, all information described below. <br />A~plicapt/operator or company name lpame to be used op permit): <br />Mobile Premix Concrete,lnc., a subsidiary of Lafarge :]orth America Inc. <br />1.1 Type of organization (corporation,parmersbip,etc.): Corporation <br />1.2 I.R.S. Tax I.D. No. or Social Secttrity Number: <br />2. Op¢ratiop game (pit, mine or site parcel: <br />3. Permitted aceaee (new or existine site): <br />3.l Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quam Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (se[ by statute) <br />~. Primarv commoditie(s) to be mined: Sand <br />oath 4tine <br />b~~ <br />5`~lJ~ <br />permitted acres- <br />acres ~ ,,rf/'-n„3 <br />acres <br />$2.344.00 application fee <br />$2.906.00 gtlam application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />Gravel Shale <br />5.1 Incidental commoditie(s) to be mined: L / IbslCoos/yr 2. / Ibslfonslvr 3. / Ibs/Tons~r <br />4. / lbs(Cons/vr 5. ! lbs(Cons(vr <br />5.2 Anticipated end use of primarycommoditie(s)tobemined: Construction Aggregates <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: Construction <br />