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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY ~'~°~'rat ~r~ <br />Department of Natural Resources <br />1313 Sherman St., Room 215 o~T i $ 2005 C O L O RA D O <br />Denver, Coiorado 90203 D I V 1 5 I O N O F <br />Phone: (303) 9663567 CONSTRUCTION MATERIAIS ~~~~~~.hiinonalg,g. - MINERAL S <br />fAX: (303) 932106 REGULAR (112) OPERATION ~~ G E O L O G Y <br />AECIAMATION•NINING <br />RECLAMATION PERMTT APPLICATION FORM SAFETY •SOENC£ <br />9i~1 OWe115 <br />Governor <br />CHECK ONE: There fe a File Number Already Assigned to this Operation <br />Russell George <br />Pernilt # M - g 2 •~-_ (Please reference [he file number ctarently assigned to this operation) E><ecvtive oireaor <br />_ New A lication ule I.4.5 Amendment A licatian ule 1.10 Ronald W. Cattany <br />PP ~ ) PP (R ) Division Director <br />Conversion Application (Rule 1.11) Natural Resource Trustee <br />Permit # M - g ~. - aS4 -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submityour <br />application, be sure to include one (1) complete siffied and notarized ORIGINAL and one (1) copy ofthe completed applicationform,rwo (2) <br />copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee described <br />under Section (4) below. Exhibits should NOT be bound or in a 3-ring bindcr; maps should be folded to 8 1 /2" X 11" or 8 I!2" X i 4"size. To <br />expedite processing, please provide the information in the format and order descnbed in this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, AId, information requested bebw. <br />1. An uticantlocerator or comnanv name (name to be used on Prrmit): L B LQ L-L-G <br />1.1 Type of organization (corporation, partnership, etc.): i-i m 1+ e ~ Li a bi I i ~ y ~~a hil <br /> <br />2. Operation same fait. mme or site Hamel: ~ ~I h3 G I O ~t ~- <br />3. Permitted acresee fnew or eiistlne site): <br />q.9 <br />®13.1 S~ <br />J4t> ~ <br />$2344.00 <br />$2.906.00 <br />$1.938.00 <br />$2.344.00 <br />_ permitted acres <br />r: acres <br />acres <br />application fee <br />quarry application <br />amendment fee <br />conversion fee <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New QuartY Application <br />4.4 Amendment Fee <br />4.5 Conversion to 1 l2 operation {set by statute) <br />5. Primary commoditie(s) to be mined: 5 2r d `] r~ _ <br />5.1 Incidrntal commoditie(s) to be mined: I . - lbs/Tons/vr <br />3. / lbs/1'ons/vr 4. / Ibslfonshr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />2. / ]bs/Taaz/vr <br />5. / Ibs/I'ons/vr <br />Office of C~ce of Colorado <br />Mined land Reclamation Active and InaRive Mines GEroloairal Survev <br />