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.;~ ~a3~ <br />~l, 938, 00 <br />STATE OF COLORADO <br />DMSIONOFMINERALSANDGEOLOGY ~ ~~=~~~E~ <br />Department of NaNral Resources 11 nr1 <br />1313 Sherman St., Room 215 I'•~'~~1~ I 2u02 D I V 15 1 O N o f <br />Denver, Colorado 80203 RECEI~/E® M I N E FLA L$ <br />Rhon=: (303)666-3507 Jivisicn et PAiOerals and CeolOgy ~ <br />FPX: (303)832-8106 A1ry~ ~ O~ G E O L O G Y <br />/1llU 0.EC LA Pt ATION <br />.. NININ G•SAFETY <br />COtiSTRUCTION NLATERLALS <br />Division of Minerals and Geology <br />REtGUL.AR (112) OPERATION ell Owens <br />RECLA?vLATION PERMIT APPLICATION FORM Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: New Application (Rule L-4.5) X Amendment Application (Rule 1.10j Michael B. Loag.~ <br />Di~isian D'vector <br />Conversion Application (Rutz 1.1 I) <br />Permit ~ h1 - 77 - 344 - (provide for Amendments and Conversions of existing permits) <br />Thz application for a Construction Ivfatzrials Rzgular ] ]2 Operation Reclamation Permit con[nins thrze major parts: (t) the application form; <br />(2) Exhibits A-$, Addzndtun 1, any sections of Exhibit 6.5 (Grotechnical Stability E.xhibit); and (3) the application fee. When you submit tour <br />application, be sure to include one (I) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Icon <br />application form, fice (b) copies of Exhibits A-S, Addendum 1, appropriate sections of 65 (Geotyhnical Stabilib~ Exhibit), and a check for the <br />application fee described under Section (4) bzlon~. Ex}ribits should NOT be bound or in a 3-ring binder, maps should be foldzd to 8 I/2" X i 1" <br />or 8 1/2" X l4" size. To expedite preczssing. please procidz [hz infommtion in the format and order described in this form. <br />GEVER.=1L OPER4T[OV IivrFORh[ATIOv <br />Type or print clearly, in the space provided, ALL inSormation requested below. <br />1. Aoolicant!oozrator or comoanv name (name to be used on permit): Holcim_ ([,tSl Iac. lfo,-mer}c Ho!nam Inc 1 <br />~. <br />1: <br />i <br />1. I T}pe of organization (corporatioq ~artrecship, etc.): ~ Coraaradon <br />11 LR.S. Tax LD. No. or Social Secu:ia Number: ±8-29137;5 <br />~ Por[laad Li^~ston2 Ouar_y <br />Operation namelpit.mine c. site namAl~: _ _ -___- _ __ , <br />Permitted acrease (new or ezis[ine site): ~ L32 _ permitted ecres <br />3. I Change in acreage (+) <br />32 Total acreage in Permit ara <br />7-t acres <br />I30G _acres <br />Fz~s: <br />d. ( New Application <br />1.2 New Quun~ Apolicuion <br />-.~ Amendment Fee <br />=.~ Convertion [0 112 opertion (set be stattae) <br />Primary commoditie(s) [o be mined: Limcstonz <br />52.=-:-1.00 application fez <br />52.906.00 quarry application <br />51.918.00 amendment fee <br />53.314.00 conversion fee <br />..I Incidental cnmmodi[ies(s)_tab~min~d: --.I_sandstone! 9?-000-16s~orsFv~--_. ;bs'Fons~~- ~- <br />3. / IbslI'onshT 4. / Ibs/TonshT 5. / lbs/TonshT <br />~.2 Anticipated end use of priman~ connrnoditiz(s) to b. mined: production of cement <br />..3 Anticipated end use of incidental commoditie(s) to bz min°,.d: roduction ofcement Fremont Conservation District <br />ozier Ave. <br />'~^ ~s;,~ Canon City, Colorado 81212 ~-'- <br />I tu) o ~ Phone (719) 275-4465 Ext 101 <br />