2006-10-24_REVISION - M1989023 (2)

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STATE OF COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY Department of Natural Resources 7313 Sherman St., Room 215 Denver, Colorado 90203 C O L O R A D O Phone: (303f 866-3567 REC ILAMAT[ON ~~~1 U~® FAR: (303) 832-9106 a,~ M I N I N G ~,~~ / `'~ '+2006 / SAFETY CONSTRUCTION MATERIA~lsron of gAcfamoiion, 1W:l;~tty c/1t~,4`S%BtJ~ Bill Owens LIMITED IMPACT (110) OPERATION Governor RECLAMATION PERMIT APPLICATION FORM Russell George Executive Director Ronald W. Canany CHECK ONE: ~ There is a File Numbey Already Assigned to this Operation Division Director ~~ pp ~1/ Natural Resource Trustee Permit # M -.LI_-gY -~ (Please reference the file number currently assigned to this operation) New Application (Rule 1.4,5) ~_ Amendment Application (Rule 1.10) Conversion Application (Rule L11) Permit # M -.~~ -~-_ (provide for Amendments and Conversions of existing permits) The application for a Construction Materials Limited Impact (110) Operation Reclamation Pemtit contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Otlice, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1 xb); and (3) the application fee. When you submit your application, be sure ro include one (1) cort>~lete signed and notarized ORIGINAL azrd one (1) copy of the completed application form, two (2) copies of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for [he application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8112" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form GENERAL OPERATION 1NFORMATTON Type or print clearly, in the space provided, ALL information described below. I. Aaolicant/ooerator or comoanv name (name to be used on oermtti: G~/d ~~i am an~ 11'1o`ht~ o~, 1.I Type oforganization (corporation, partnership, etc.): 2. Operation name loll. ndne or site name]: GA ~ ~ r~-c-~ ~~.oc~ /~ f'i~ 3. Permitted acreage (new or eaistine site): ~ r 5 permitted acres 3.1 Change in acreage (+) ~+ 2.9 acres 3.2 Total Acreage in Permit Area ~~ acres 4. Fees: 4.1 New Application: 1094.00 application fee Amendment Fee (C.R.S. 34-32.5-125(II)): 7] .00 application fee 4.2 Conversion Fee (from 110d to 110 75.00 conversion fee (Rule 1.11.2(2)) 5. Primary commoditie(s) to be mined: ..SoL~d 0.1/ 5.1 Incidental commoditie(s) to be mined; 1. ~1 / ~ lbs/Tons/vr 2. / Ibs/Tons/vr 3. / ]bs/fons/vr 4. / lbs/Tons/vr 5. / Ibs/fons/vr 5.2 Anticipated end use of primary commoditie(s) to be mined: f~ [i ~ ~S~ Anticipated end use of incidental commoditie(s) to be mined; N ~~ Office of ~ Office of Mined Land Reclamation Active and Inattive Mines