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ECEIVED RECEIVED <br />APR 13 2005 ~ 1AN 2 62005 <br />Division of Minerals and Geology Division of Minerals and Ceolopy <br />~" CONSTRUCTION MATERIALS <br />,. .,, .. <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br /> <br />~r,i ~ 2 (r Lu~~ <br />~ /VI - ( r/ <br />CHECK ONE: X There is a File Number Already Assigned to this Operation <br />Permit # M - 1981=07 5 (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) X Amendment Application (Rule 1.10) <br />/ Conversion Application (Rule 1.1 I) <br />~' Permit # M - 1981- O 7 S_ (provide for Amendments and Conversions of existing permits) <br />The application for a Coastnrciion Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by <br />the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and{3) the application fee. When you submityour application, be sure <br />to include one (1) complete siened and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of <br />Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described under (4) below, Exhibits should ~~ be bound or in a 3-ring binder; maps ahouldbe folded to 81/2" X 11" or 8 <br />]/2" X 14" size. To expedite processing, please provide the information in the format and order desccibedm this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clesrty, in the space provided, ALL informatlon described below. <br />1. Aoolicsnt/ooerator or comoanv name (name to be used on nermitl" Phi 1 i lp 5 Stone Comp ariy c/ <br />1.1 Type oforgaaizadon (corporation, partnership, etc.): Corporation <br />19931089779 <br />1.2 LRS. Tax ID No. or Social Security Number: / <br />2. Ooeratlon name (nif. mine or site namel: Phil l <br />3. Permitted acreage (new or eiistina sitel: <br />3.1 Change in acreage (+) <br />~s Stone Com <br />3.2 Total Acreage in Permit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.RS. 34-32.5-125(II)): <br />4.2 Conversion Fee (from 1104 to 110 875.00 conversion fce (Rule 1.11.2(2)) <br />S. Primary rnmmoditie(sl to be mined: Sandstone _ <br />5.1 Incidental commoditie(s) to be mined: 1. / ibs/fans/vr <br />N/A 4. / lbs/foas/yr <br />5.2 Anticipated end nse of primary commoditie(s) to be mined: <br />Anticipated end use of incidental commoditie(s) to be mined: <br />i-6.9 acres <br />_ 9.9 acres <br />719.00 application fee <br />2. / lbs/Tons/vr 3. / Ibs/fons/vr <br />5. / Ibs/fons/yr <br />Building Material <br />N/A <br />3 pemtiued acres <br />