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"~ <br />RECEIVED ~~C°~`'S <br />JAN 26.2005 ~~'~~`~ .d~,° <br />~ a ~ „n,. <br />_ Olvision afRAiaereis and Geology - ~ 2 ~~ ~uJ~ <br />CONSTRUCTION MATERIALS <br />LIhIITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CFIECK ONE: % There is a Flle Nnmber Ahready Assigned to this Opera <br />Pemit # Ivy- 1981=Q75 . (please reference the file number fly assigned to this operation) <br />New Application (Rule 1.4.E X ' endment Application (Rule 1.10) <br />Conversion Application (Rule 1.1 I) <br />Permit # M _ 1981- 07 5_ {proms for Am dments and Conversions of existing permits), <br />The application for a Construction Materials Limited Impact (110) lion Reclamation Permit contains three major parts: (1) the <br />application form; (2) F.xhrbits A-J, Exhibit L, Addendum 1, any sec ' ns of Exhibit 6.5 and Gwtcehnical Stability Exhibit, as required by <br />the Office, and outlinedin Rules 6.1, 6.2, 6.3, 6.5, and L6.2(Ixb); d{3) the application fee. whenyon submit your application, be sure <br />to include o~ (1) co lete si a and notarized ORIGINAL nd one (1) roPY of the wmpleted application fomy two {2) copies of <br />Exhibits A-J, Exhibit L, Addendum 1, and appropriate secti of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described under (4) below. Exhibits should T be bound or in a 3-ring binder, maps shouldbe folded to 81/2" X 11"or 8 <br />1/2"'X 14" size. To expedite processing, Please provide information is the format end order described in this form: <br /> G OPERATION INFORMATION <br />Type or print clearly, in a apace provided, ALL informatlon described below. <br />1. A ucsnt/o erator rco an name smeto edon Robert ,7• and Frances A, Phillips <br />1.1 Type oforgmiTation(corporatio parmership,etc.): Corporation <br /> <br />1.2 `~ 19931089779 <br />I.R.S: Tax ID No. or Social urity t~Iumber: ~ ~- <br />2. eratlon-name i mine or ename:Phillips Stone Company, Inc. , Nolan Quarries <br />3. Pe fled acrea a ne or site : ~ - 3 ~ permitted acres <br />3.1 ,Change in acreage (+ -F6 , 9 acres <br />3.2 Total Acreage in P 't Area 9. 9 saes <br />4 ~. <br />4.1 NewApplica' n; ' <br /> Amendmen ce (C.RS. 34-32.5-125(II)): 5719.00 application fee <br />4.2 Conversio Fee (from 110d to 110 875.00 conversion fce (Rule 1.11.2(2)) <br />5.. Ptimat co moditlea to be mined: "Sandstone <br />5.1 Inci~ tai commoditie(s) to be mined: 1. / lbs/I'ons/vr _ 2. _ / Ibs/I'ons/vr 3. ~ ~ / ~ lbs~l'oas/vr <br />N/A 4. / Ibs/fons/vr 5. _ / lbslfons/~r <br />5.2 ticipated end use of primary commoditie(s) to be mined: Bui l d iri£ Material <br />cipated end use of incidental commoditie(s) to be mined: N ~ p' <br />