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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866.3567 <br />FAX: (3~~E,3~~, I~D <br />FILE COPY <br />Fos scaNaeNc <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING•SAFETY <br />JAN ~ 12003 / CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION / <br />Division of Mineraic and Geology RECLAMATION PERMIT APPLICATION FORM / <br />CHECK ONE: There Ls a File Number Already Assigned to this Operation <br />Permit # M - 74 - 06 - 9 (Please reference the Ste number cltrrently assigned [o this operation} <br />_ New Application (Rule 1.4.5) <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cattany <br />Acting Division Director <br />X Amendment Application (Rule 1.10} <br />„Conversion Applic rice (Rule 1.11) <br />Permit # M - ~ 4 _ 069 __ (provide far Amendments and Convereions of existing pertniU) <br />The appbcation for a Construction Materials Regular 112 Operation Reclamation Perffit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhtbit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be swe to include one (1) co»le~ signed mmd notarized ItrORY ORIGINAL and one (1) copy of the completed ~ application <br />form, two (2) copies ofExhrbits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee desenbed ender Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 lt2" X l ]" or 8 1/2" <br />X 14" size. To expedite ptncessiog, please pmvide the information in the format and order descabed in this form, <br />GENERAL OPERATION INFORMATION <br />Type or print cleaHy, in the space provided, ALLinformation requested below. <br />1. AnolicaoUoneratororromaaovname(nametobeusedonnermit): Loveland Ready Mix Concrete, Inc, / <br />1. ] Type of organization (corporation, partnership, etc.): <br />ion <br />1.2 IRS. Tax I.D. No. or Social Security Number: <br />2. Operation name (nit-mine or site Hamel: <br />3. Permitted arreaar (sew or rsistins sire3: <br />3.1 Change in acreage (~) <br />3.2 ToSa'. acreage in Per ~~£ area <br />4. Fees: <br />4.1 New Application <br />4.2 New Qnarn, Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set b}' statute) <br />195 permiiizd ages <br />0 acres <br />195 acres <br />$2344A0 application fee <br />$2,906.00 gttarryapplication <br />51.938.00 amendmcatfk <br />52,344.00 conversien fee <br />~. Primary commoditie(sl to be mined: Sand Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. Nnne- Ibs/TonsPor <br />3. / lbs/Tons/vr 4. / lbs/Tonsivr <br />2. / Ibs/TonsJvr <br />S. 1 1bsrTons(vr <br />5.2 Anticipated end use of primarycommodi6e(s)tobemined: Concrete AK>;reQate/Structural Fill <br />5.3 Anticipated sod use of incidental commoditie(s) to be mined: <br />