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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />t 3135herman St., Room 275 R~m..c ~€p~q rr-~ ptv[stON OF <br />Denver, Colorado 80203 6.c ;;,,, Y t. ~ ' ' <br />Phone: (303) 866-3567 ~ MINERAL S <br />FAX: (303) 832-8106 CONSTRUCTION MATERLhLS /jqN 3 1 2005 G E O L O G Y <br />LIMITED IMPACT (110) OPERATION R E C L A M A T I O N <br />MINING•SA FETY <br />RECLAMATION PERMIT APPLICATION FORM rlai0n al Minerals and Geolagx <br />Bill Owens <br />Governor <br />Greg E. Walc'rer <br />CI-LCK ONE: ~_ There is a File Numbej Already Assigned to this Operation Exee~ti~e oireaor <br />t/ Ronald W. Carany <br />Permit # M -.1~75_•~6 3 (Please reference the file number currently assigned to this operation) Acting Division Director <br />New Application (Role 1.4.5) ~ A~m/endmeatApplication(Rnle L10) <br />Conversion Application (Rule 1.] 1) /TS ~~~'~/t(/CAL ~~U(S~U/"'' <br />Permit # M - 1 9 7 9 _ 1 6 3 (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotec6nical Stab' ' Exhibit, as required b}' the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When you su it your application, be sure to <br />include one (1) complete signed and notarized IVORY ORIGINAL and one (1) copy of the completed IvO~2 rr application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate secfions of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described nnder j4) below. Exhibits should NOT be bound or is-a 3-ring binder; maps sho.ild be folded is 8 Ill" X 11 " or <br />8 1/2" X 14" size. To expedite processing, please provide the information in Ute format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL i~'ormation described below. <br />1. Applicant/oyerator or rnmoanv name (name to be used on oermitl: T.a s Animas County/ <br />1.1 Type of organization(catporation,parlnetship,etc.): County Government <br />1.2 I.RS. Tax ID No. or Social Security Number: 2.: <br />2. Onerationname(niR,mineor~itename): gh;,nnnr, n;1- <br />3. Permittedacrea¢e(neworeaistin¢site): 9.79 - 1,09 (released) + 1.09 TR 9.79 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Pemtit Area _o~ro__ acres <br />4. Fees: <br />4.1 New Application: $1,094.00 application fee <br />Amendment Fee(C.RS.34-32.5-125(II)): $7]9.00 application fee <br />4.2 Conversion Fee (from 110d to 110 $875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primarvrnmmoditie(sltobemined: Road base materials <br />5.1 Incidental commoditie(s) to be mined: 1.11grt/® 1bsJ1'ons/vr 2. / Ibs/Tons/vr 3. / ]bs/Tonslvr <br />4. / lbs/Tons/vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s)tobemined: base materials for County Rds <br />Anticipated end use of incidental commoditie(s) to be mined: <br />