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TATE OF COLORADO <br />CIIVISION OF MINERALS AND GEOLOGY <br />Uepanmen[ of Natural Resources <br />[ 313 Sherman St, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866.3567 <br />FAX: (303) 832.6106 <br />,/ JUL 08 2004 coLOiznDo <br />CONSTRUCTION MATERIALS D I V I a I O N o f <br />Division of Minerals & Gealo ~ I N E RA L S <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a F'de Number Already Assigned to this Operation <br />Permit # M -~-~-_ (Please reference the le number currently assigrted to this operation) <br />_ New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) <br />X Conversion Application (Rule I.I 1) ,,,/// <br />Peratit # Iv _- 1 9 - 9 8 - 0 5 4 (provide for Amendments and Conversions of existing permits) <br />GEOLOGY <br />0.ECLAN ATION•NINING <br />SAFETY•SCIENCF <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive DIrCCtor <br />Ronald W. Cattany <br />Division DIEMOr <br />Natural Resource Trustee <br />The application for a Construction Materials Regular l 12 Operation Reclamation Petmit contains three major parts: (1) [he application fotm; <br />(2) Exlubits A-S, Addendum 1, airy sections of Exhibit 6S (C,eotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete si®ed and notarized IVORY ORIGINAL and one (1) copy ofthe canpleted Ivory application <br />form, iuo (2) copiesofExhibits A-S, Addendtnn 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ling binder, maps should be folded to 8112" X 11"or 81/2" X <br />14" size. To expedite processing, please provide the information in the format and order described in this form. <br /> GENERAL OPERATION INFORMATION <br /> <br />Type or print clearly, in the space provided, ALL infomtation r'e9 n ~/ <br />ested below. (..~/V - I r/ <br />1. Ap plicant/oneratororcomoaovname(nametobeusedoncermitl: Rio Blanco County Road & Bridge <br />1.1 Type of organization(corporatiogparmership,etc.): County Government <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br /> / <br />2. Clo erationnsme(oit"mice oraiteoame): East Douglas Creek Gravel Pit / <br />3. Permitted aereaQe (new or eaistine aitel: 9. 9 9 permitted acres <br />3.1 Change in acreage (+) 5 . 3 0 acres <br />3.2 Total acreage in Permit area 1 5 . 2 9 acres <br />4. Fees: <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarty Application $2.906.00 quarry- application <br />4.4 Amendment Fee $1.938.00 aznendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 wnversion fee <br />5. Prtman• rnmmoditie(s) to be mined: Grave 1 <br />5.1 Incidental commoditie(s) to be mined: I . - Ibs/TonsAT <br />3. / lbs/T'ons/vr 4. / lbs/TonshT <br />2. / lbsrfonshT <br />5. / Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s)tobemined: Road Surfacing <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined land Reclamation ~ Active and Inactive Mines Geological Survey <br />