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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />7313 Sherman 5[., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303)832-8106 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CFIECK ONE: There i9 a Ft7e Number Already Assigned to this Operatiou <br />Permit # M -_ _ _ (Please reference the Sle number cuttently assigned to this operation) <br />New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -~~- VCiY -_ (provide for Amendments and Conversions of elcisting permits) <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />ftEC LAMATION <br />tAINING•SAFETY <br />sin ovens <br />Governor <br />Greg E. Walther <br />Enecutive Director <br />Ronald W. Cottony <br />Acting Division Director <br />The application for a Colrsnttction Materials Regular 112 Operation Reclamation Pt:~it contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum I, a~ sections of F.xhrbit 65 (Geotechnical Stability F.xhtbit; and (3) the application fee. When you submit your <br />application, be sate to include one (1) complete signed mmd notarized IVORY ORIG]NAL aad one (1) copy of the completed I~ application <br />form, two (2) copies of Exhrbits A-S, Addendum 1, appropriate sections of 6.5 (Geot~lmical Stability Exhibit, and a check for the application <br />fee descnbed under Section (4) below. Exhibits should NOT be botmd or in a 3-ring binder; maps should be folded to 8 12" X 17" or 8 1 /2" <br />X 14" size. To expedite processing, please provide the information in the format and order descnbed in this form. <br />GENII2AL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, ALL information requested below. <br />1. A~plicanUoperator or company name (name to be used on permitl: L4 F'-Iil26E 1~E57'. S/JG <br />l .l Type of organization (corporation,-parmersltig, etc.): ~,U1f 002,4T1Oti1 <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: a S - 1~~' 3 I Z9S <br />2. Operation name fort. mine orskenamel: S1~E~IGIG}l~fn.~l /~6C•;YIt6A~ri <br />3. Permitted acrease (new or evstine shtel: a ~.3. '4- praiitted acres <br />3.1 Change in acreage (+) 7~ e g acres <br />3.2 Total acreage in Permit area aC,) e 2 acres <br />4. Fees <br />4.1 New Application $2344.00 application fee <br />4.2 New Qmrry Application $2 906.00 gnarty application <br />4.4 Amendment Fee $1.938.00 amendmear far <br />45 Conversion to ] 12 operation (sei by statute) $2.344.00 wnversion fee <br />~. Primary rnmmoditie(sl to be mined: Sroy E- <br />s.I Inoidental commoaitie(s) to be mined: 1. N ~ - Ibsffpnslvr 2. / 1bs/h Dns/vr <br /> 3. / Ibs/Tons/vr 4. / Ibs/Tons/vr 5. / Ibs/fons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: l..OdlST121.1U7aN M (4'TZ-~2l #~S <br />5.3 Anticipated end nse of incidental commoditie(s) to be mined: N p - <br />