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.2~ <br /> STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />13135hennan St., Room 215 RECEIVED COLORADO <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS D 7 V l 5 1 0 N o f <br />MINERAL S <br />Phone: (303) 8663567 <br />FAX: (3031 e32~toa REGULAR (112) OPERATION ~ JUN 15 2004 G E O L O G Y <br /> RECLAMATION PERMTT APPLICATION FORM PECIAMATION•NINING <br /> Division of Minerals & Geolo sAFETY•SCIENCE <br />CHECK ONE: X There is a File Number Already Assigned to this Operation <br />Bill Owens <br />Governor <br />Permit # M - ~ lease reference the file number cturentl assi ed to this o ration Gres E. Wapner <br />~Z-5-31+--- (P y ~ Pe ) Executive Director <br />_ Nero Application (Rule 1.4.5) ~_ Amendment Application (Rule L 10) Ronan w. canany <br />Division DirecTOr <br />_ Conversion Application (Rule 1.11) Natural Resou¢e Trustee <br />Permit # M - 77 - 534 -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular ] 12 Operation Reclamation Permit contains three major pans: (I) the application form; <br />(2) Exhibits A-S, Addendum 1, atry sections of Exhibit 6.~ (Geotechnical Stability Exhibit; and (3) the application fee. When you submityow <br />application, be sure to include one (1) complete sired and notarized IVORY ORIGDVAL and one (1) copy of the completed I~ application <br />form, two (2) copies ofEtdtibits A-S, Addendum 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-ring binder, maps should be folded to 81(2" X 11" or 812" X <br />l4" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print ckady, m the apace provided, ALL information requested bebw. <br />AnnlicanUoHerator or comoanvname (name to be used tm Hermit): ('; t~ n f Onl d Pn <br />1.1 Type of organization (corporation, partnership, etc J: Mnn; ci na1 ; rv <br />1.2 I.R.S. Tax I.D. No. or Social Security Nttmber: 9A_n44F,h <br />2. Operation name (nit. mice or site name): Empire P i t <br />3. Permitted acreage fnew or ettiatlne site): 131.6 6 permitted acres <br />3.1 Change in acreage (+) + 6.9 2 acres <br />3.2 Total acreage in Permit area 138.58 acres <br />4. Fees <br />4.1 New Application $2.344.00 application fee <br />42 New Quarry Application $2 906. quarry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Primary rnmmoditiets) to be mined: Sand Gravel Road Base <br />5.1 Incidental commoditie(s) to be mined: 1. N/A - Ibs/Tons/vr 2. / Ibs/I'ons/vr <br />3. / Ibslfons/vr 4. / ]bs/Tons/vr 5. / Ibs/Tons/vr <br />5.2 Anticipa[edenduseofprimarycorntnoditie(s)tobemined: Construction apQre~ates <br />5.3 Anticipated end use of incidental commoditie(s)tobemined: None anticipated <br />Office of C~ce of Colorado <br />Mined Land Rxlamation Active and Inactive Mines Geological Survey <br />