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III IIIIIIIIIIIIIIII • • moo <br /> STATE OF COLOMDO _ <br /> DIVISION OF MINERALS AND GEOLOGY <br /> Department of Natural Resources <br /> Den,Sherman Si.do 0203oom 115 RECEIVED <br /> Denser,Colorado 80?03 D I v 15 1 0 N O F <br /> Phone:(303)866-3567 M I N E RA L S <br /> FAX'.(3031 831-8106 <br /> MAY 0 8 2000 & <br /> J�0 GEOLOGY <br /> �\ RECLAMATION <br /> nlvlslon of Minera►s&Geology M I N I N G-S A F E T Y <br /> �lCj �QQO � CONSTRUCTION MATERIALS <br /> `` � ep,' Rik ovens <br /> N &O LIMITED IMPACT(I10)OPERATION Governor <br /> \�S¢`.�S RECLAMATION PERMIT APPLICATION FORM Greg E.Watcher <br /> Executive Oicenur <br /> O <br /> �GQ Michael B.Long <br /> Division Director <br /> CHECK ONE: New Application(Rule 1.4) Conversion Application(Rule 1.11) <br /> Amendment Application(C.R.S.34-32.5-110) <br /> Permit k M - -_(�p� (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Limited Impact(110)Operation Reclamation Permit contains three major parts: (1)the application form; <br /> (2)Exhibits A-J,Exhibit 1.,Addendum 1,any sections of Exhibit 6.5 and Geotechnical Stability Exhibit,as required by the Office,and outlined in Rules <br /> 6.1, 6.2,6.3,6.5,and 1.6.2(1)(b); and(3)the application fee. When you submit your application, be sure to include one(1)complete sieved and <br /> notarized IVORY ORIGINAL and one(1)copy of the completed Ivory application form,two(2)copies of Exhibits A-J,Exhibit L,Addendum 1,and <br /> appropriate sections of 6.5(Geotechnical Stability Exhibit),as required,and a check for the application fee described under(4)below. Exhibits should <br /> NOT be bound or in a 3-ring binder,maps should be folded to 812"X 11"or 812"X 14"size. To expedite processing,please provide the information <br /> in the format and order describediri this form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly,in the space provided, ALL information described below. <br /> 1. Applicant/operator or company name(name to be used on permitl: P`Z9 <br /> 1.1 Type of organization(corporation,partnership,etc.): Si7/- - 4-;'iao& <br /> 1.21 I.R.S.Tax ID No.or Social Security Number: 5--4K5 - R— y 1 O 7 <br /> t (J <br /> 2. Operation name(pit,mine or site name): Zvi! L> k DI� 4 A'CR ! A "b A4 e- I� -Z <br /> 3. Permitted acreage(new or existing sitel: IiN969 permined acres <br /> 3.1 Change in acreage(+) OLII� acres <br /> Total Acreage in Permit Area ej'4�acres <br /> 4. Fees: <br /> 4.1 New Application: _$875.00 application fee <br /> Amendment Fee(C.R.S.34-32.5-125(11)): S575.00 application fee <br /> 4.2 Conversion Fee(from 11 Od to 110$875.00 conversion fee(Rule 1.1 1.2(2)) <br /> 5. Primary commoditie(s)to be mined: S 'd �;7D�-� <br /> 5.1 Incidental commoditie(s)to be mined: 1. Ibs/Tons/yr 2. Ibs/Tons/vr 3. Ibs/Tons/vr <br /> 4. Ibs/Tons/vr 5. Ibs/Tons/vr 1 <br /> 5.2 Anticipated end use of primary commoditie(s)to be mined: r.p 1/5/?d <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: <br />