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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY RECEIVED <br />Department of Natural Resources <br /> <br />7373 Sherman St., Room 215 99 <br />SEP ~ <br />O ZOO <br />'/ <br />Denver, Colorado 80203 , <br />J <br />Phone: (303) 866-3567 . <br />FAX: (303) 832-8106 Division ~f Minerals and Geology <br /> CONSTRUCTION MA~'EBIALS <br /> REGULAR (112) OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: x There re a Foe Number Already Assigned to this Operation <br />Permit # M -~- eto0 -_ (Please reference the Sle number cuaently assigned to this operation) <br />New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />X Conversion tjpplication (Rule 1.11) / <br />t/ n }~ ` _ <br />Permit # M -zoo It -~-_ (provide for Amendments and Converoions of~exivsting permits) <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />eiu ovens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cottony <br />Acting Division Director <br />The application for a Construction Materials Regular 112 Operation Reclamation Pest contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Attdendttm 1, a~ sections of ExhtbH 6.5 (Geotechnical Stabtb'ty Exhibit and (3) the appfication fee. When you submit your <br />application, be sure to include one (1) comolete siffied and notatved NORY ORIGINAL and offi (1) copy of the completed I~ application <br />form, two (2) copies ofExhtbits A-5, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhtbit and a check far the application <br />fee described under Section (4) below. Exhibits shonldNOT be bouud m in a 3-ring binder; maps should be foSded to 812" X 11" or 8 If2" <br />X 14" size. To expedite processing, please provide the information in the format slid order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, ALL information requested below. <br />Annlicant/onerator or comaany name (name to be trued on oermitl: <br />I.1 Type of orgam2atian (corporation, patmership, etc.): L_ <- e <br />1.2 I.RS. Tax I.D. No. or Social Security Number: <br />2. Oneration name (pit, mine or site name): <br />3. Permitted acrease (new or existins she): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />33 c rLl~"R Pe~-S ES . ~L_C <br /> <br />l~ c 4.t_L..t S 'i~'G'f <br />4. Fees: <br />4.1 New Application <br />42 New Qmrry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set b}' statute) <br />~. Primary commoditie(s) to be trained: ~i2R v t2 50.r.1 ~ <br />:rte ~ <br />5.1 Incidental commoditie(s) to be mined: I. arRr - I ODD Ibs/Tons/yr <br />`j •9~ permittedazres <br />13 .~ acres <br />z a , s9 acres <br />$2.344.00 application fee <br />52 906.00 quarry application <br />51.938.00 amendmzat fez <br />52.344.00 conversion fee <br />2. / Ibs/Tons/vr <br />3. / Ibs/TonshT 4. / Ibs/fons/vr 5. / lbslTonslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~ _ ^r s ra v trio •.J m q ~-rL,=~,4 ~ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: GD"~s r'~'~cr~ ~^~ f) ~ T~~a- A t- <br />