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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY RE <br /> <br />Department of Natural Resources CEIVED <br />1313 Sherman St., Room 215 <br />Denver, Cobrado 80203 AUG~~08 2003 <br />Phone: (303) 866-3567 <br />FAX: (31 <br />1 <br />~2D <br />®PY <br />~ <br />~ <br />~, <br />~ Oirision of Minerals and Gealoyy <br />/~~/ <br />® ~~~~~~'°~ CONSTRUCTION MATERIALS <br /> <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: ___~__ There is a Ft7e Number Already Assigned to this Operation <br />Permit # M -~_-,~O -_ (Please reference the file number currently assigned to this operation) <br />New Applicafion (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -Zoo -~Q-_ (pmvide for Amendments and Conversions of existing permiU) <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />Bill Owens <br />Governor <br />Greg E. wakher <br />Executive Director <br />Ronald W. Cattany <br />Acting Division Director <br />The application for a Construction Materials Regular 112 Operation Reclamation Peru contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendma 1, any sections of Exht3it 6.5 (Geotechnical Stability Exhrbit; and (3) Ste application fee. When you submit yoar <br />application, be slue to i~lude one (1) complete signed and notarized IVORY ORIGINAL and one (1) copy of the completed I~ application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, ~d a check for the application <br />fee described ender Section (4) below. Exhibits should NOT be bound or in a 3-ring binder maps should be folded tD 8 12" X 11" or 8 1/2" <br />X 14" 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 space provided, ALL information requested below. <br />1. ApolicanUooerator or comuanv name (name to be used on txrmitl: 3 ~ C ~1Tc2 P CLT-Sc~ y ~-L- L <br />1.1 Type of organization (corporation, partnership, etc.): L L G. <br />1.2 I.RS. Tax I.D. No. or Social Security Number: 4-t - o S g (\ ~~ <br />2. Ooeration name (oit-mine or site Hamel: ~ ~4-~=~~ ~T /y ,~~~ ,~~~ <br />3. Permitted acrea_e (new or evstina sitel: '(.QY 1 v /permitted acres <br />3.1 Change in acreage (+) ~ ~~ 3 . into acres <br />3.2 Total acreage in Permit area a~.~-rS`/ • acres' <br />4. Fees <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.i Conversion to 112 operation (set by staNte) <br />~. Primarvrnmmoditie(sltobemined: GKAv~ SRniy~ <br />5.1 Incidental commoditie(s) to be alined: 1. rst-LD~Q v /rxc Ibs/1'ons/yt 2. _ <br />3. ! lbs/Tons/vr 4. / lbslfonslvr 5. _ <br />5.2 Anticipated end use of primary commoditie(s) to be mined: C'oAr 5 i7Z/C'T.ro~1 <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: Co~S'7-/~ /c7Ti <br />$2.344.00 application fee <br />$2.906.00 gentry application <br />$1.938.00 amendmeatfee <br />$2.344.00 conversion fee <br />/ Ibs/Cons/vr <br />lbslTons/vr <br />