1997-02-12_REVISION - M1985043

• Permit No: M1985043
• IBM Index Class Name: Revision
• Doc Date: 2/12/1997
• Doc Name: CONSTRUCTION MATERIALS REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FORM
• Type & Sequence: AM1
• Media Type: D
• Archive: No

• III III III III IIII III
999
STATE OF COLOMDO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources
1313 en,er.ermanColor St do Room 2 i 5 ;`(�L
Oenvc•r.Colorado 80203 v
Phone:[phone]
FAX [phone] CCp
1 CA 12 1997 DEPARTMENT OF
NATURAL
CONSTRUCTION MATERI ALS
.on nI lainoras&Geoluy) RE URCE
REGULAR OPERATION (112)
RECLAMATION PERMIT APPLICATION FORM Roy RomerGo.ernor
lames S.Lochhead
E.ecmwe D�,eaor
michael B.Lon);
D.>Ision Dueuo,
CHECK ONE: New Application (Rule 1.4,5) �_ Amendment Application (Rule 1.10)
Conversion Application (Rule 1,11)
Permit �_-��- 04 (provide for Amendments and conversions of
existing permits)
The application for a Regular 212 Operation Reclamation Permit contains three major parts: (1)
the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6. 5 (Geotechnical
Stability Exhibit; and (3) the application fee. When you submit your application, be sure to
include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed
ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5
(Geotechnical Stability Exhibit, and a check for the application fee described under Section (4)
below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11"
r 4 1/2" X 14" size. To expedite processing, please provide the information in the format and
L .ar described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly in the space provided the information requested below.
1. Applicant/operator or company name (name to be used on permit) :
1.1 Type of organization (corporation,. partnership, etc. ) : co
1.2 I.R.S. Tax I.D. No. or Social Security Number: 5"71- ys
2. Operation name (pit, mine or site name) : gTj CIJArVOA) QUA121ZY
3. Permitted acreage (new or existing site) 3 N permitted acres
3.1 Change in acreage (+ or -) D acres
3.2 Total acreage in Permit area acres
4. Fees:
4,1 New Application S1,875.00 application fee
4.2 New Quarry Application $2,325.00 quarry application
4,3 Milling Application (Non-DMO) $3,100.00 milling application
4,4 Amendment Fee $1, 550.00 amendment fee
4.5 Conversion to 112 operation (set by statute) S1,875.00 conversion fee
S. Primary commodities) to be mined: 44a % 5�qq ld
5.1 Incidental commoditie(s) to be mined: 1. A $i:6- lbs/Tons/vr
2. t{A)(-'1U0UYJ 6f1JJ1A7CU'A1lbs/Tons/vr 3. / lbs/Tons/yr
4. / lbs/Tons/vr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie s) to be mined: Cee!S7,-f1A 07ed
5.3 Anticipated end use of incidental commodities) to be mined: Lrrv,�crcwiJ