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~rn- l <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY F'~~ COY <br />Department of Natural Resources yry;,/~p <br />137 3 Sherman St., Room 215 ~!®g S~ANN~I R 6i' C E ~ ~l E D <br />Denver, Colorado 80203 DIVISION O F <br />Phone: (303) 866-3567 MINERAL S <br />FAX: (303) 832-8106 APR 2 5 X002 / & <br />GEOLOGY <br />CONSTRUCTION MATERIAL~ivision of Minerals and GeolagY R E C L A M AT I O N <br />MINING•SAFETY <br />LIMITED IMPACT (110) OPERATION <br />Bill Owens <br />RECLAMATION PERMIT APPLICATION FORM Governor <br />Greg E. Walther <br />Executive Director <br />Michael B. Long <br />CHECK ONE: New A licafion Rule 1.4) Conversion A lica[ion Rule °" oireaor <br />PP ( PP ( -~ <br />R Amendment Application (C.R.S. 34-32.5-110) <br />Permit# M -1978 096_ (provide for Amendments and Conversions of existing permits) <br />The applicaflon for a Construction Materials idmited Impact (110) Operaton Reclamation Perini[ contains three major pazts: (1) the application form; <br />(2) Exhibits A-J, Exhibit L, Addendum 1, any secflons 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 applicaflon, be sure to include one (1) complete sieved and <br />notazized IVORY ORIGINAL and one (1) copy of the completed Ivorv applicaflon form, two (2) copies of Exhibits A-J, Exhibit I-, Addendum 1, and <br />appropriate sections of 6.5 (Geo[echnical StabIlityExhibi[), as required, and a check for the applicaflon fee described under (4) below. Exhibits should <br />NOT be bound or in a 3-ring binder; maps should be folded [0 8 1/Z" X 11 " or 8 1/2" X 14" size. To expedite processing, please provide the information <br />in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. ApplicanUoneratororcomoanvname(name'~tobeusedonoermit): Fremont ~ntv Board of Commissioners <br />1.1 Type of organization (corporation, pazmership, etc.): Government Agency <br />1.2 LR.S. Tax ID No. or Social Security Number: <br />Operation name (ait, mine or site name): Coaldale Pit -Dist ll3 '~ <br />Permitted acreaee (new or existine site): 5 permitted acres <br />3.1 Change in acreage (+) 4.9 acres <br />Total Acreage in Permit Area 9 : 9 acres <br />Fees: <br />4.1 New Application: $1.094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): $719.00 application fee <br />4.2 Conversion Fee (from 110d [0 110 875.00 conversion fee (Rule 1.11.2(2)) - <br />Primary commoditie(s) to be mined: Road Materials/Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. 10 , 0{d0 ~pjs(/Tons/vr) 2. / lbs/I'ons/vr 3. / Ibs/Tons/vr <br />4. / lbs/I'ons/vr 5. / lbs/Tonslvr <br />5.2 Anticipated end use of primazy commoditie(s) [o be mined: <br />Road Materials/Gravel <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br />