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cN-ai <br />STATE OF COLORADO <br />DIVt510N OF MINERALS AND GEOLOGY <br />I)eDaMKnt of Wtunl Resounss R /~• <br />[313 SFtemNVr St., Room 215 • •~r ^•^ '~®COLORADO <br />~~ CdRadp R0243 D f V l 5 1 0 N O F <br />Phone: 1303) [[66.3567 CONSTRUCTION MATERIALS M I N F~, RA L $ <br />FAX: (303)8377!% REGULAR (112) OPERATION JAN 1 0 LU06 G E O L O G Y <br />RECLAMATION PERMIT APPLICATION FORM fESAEETY•fGIfNGENa <br />Division o(Minerals and 6eologp-- <br />alll Oxem <br />Gmemor <br />CHECK ONF.': _~_ There ro a Fik Numher Already Assiped W this Operation xu:~n ~~ <br />Pennii # M ~. 9 -7 9 -10 3 (Please referawe the file number currently assigned to this operation} Fveouive Dlaztar <br />New A lication Rule 1.4.5) Amendment A lication uie 1.10 Ratite w. r~mnr <br />PP ( PP (R ) Divisim Dinxb~ <br />R Conversion Application (Rule 1.1 I) Nanial X011¢ T""f0` <br />Pcmtit # M - 1 9 _7 9 -10 3 (pro~tide for Amefrdpfema and Conveniooa of existing permits) <br />The application for a COfltilreCllon Materials Regulaz 112 Operation Reclamation Peflnit contains throe major parts: (1) the application form; <br />(2) Exhibits A-S, Adderdrau 1, any sections of Exhibit 6.5 (Geotochnical Stability Exhibit; and (3 j the application foe. When you submit yo'a <br />applicetimy be sure to include cafe (I) complete simfed end notarized ORIGINAL and one (1) copy oClhe completed application fottn, twe (2) <br />copies of Exhibits A-S, Addendwn 1, appropriate sections of 65 (Geotechnical Stability Exhibit, and a check for the application fee desaibed <br />urWer Section (4)below. Exhibits slwuldNOT be bound or ina3-ring bind maps should befolded to8 l/2"X 1!"ar812"X 14"size. To <br />expedite processurg, Please provide the information W the forme[ end older desefibed N this fotm <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, m the apace provided, L tmtormation requested bebw. <br />i. ADnRcant/otFerator or oomoanv name (name to be used on txlvEkl: Diana K . W a t S o n <br />i.l Type of organize[ion(corporation,parlrterslup,ete.): Individual <br />2. Op ration name (pit. mine or site camel: Am 1 c k P i t <br />3. Perm kted aer+esae (aeFV or esktipR eke): 9 • 9 permitted acres <br /> 3.1 ChaDBe N acreage (+) 8 4 . 2 acres <br /> 3.2 Total acreage in Permit area 9 4 . 1 ~ acres <br />4. Feea: <br /> 4.1 New Applicalifm $2344.00 application fee <br /> 4.2 New Quafry Application X2.906,00 gftarry application <br /> 4.4 AmendmafiFce $]-938.00 amerfdmcnt fee <br /> 4.5 Conversion to ] 12 upemtion (set by statute) $2 344.011 conversion fee <br />i. Prim ary eommodkie(a) to he mined: g r a ygl sand S t O ri e <br /> 5. I Incidental conm~odi[ie(s) to be Dritted: I .none - Ibs/I'ons/vr 2. ! 1bslTonslvr <br /> 3. / Ibs/fons/yr 4. 1 lbs/fons/vr 5. / Ibs/fons/vr <br /> 5.2 Anticipatede~useofp m rycommoditie(s)lobemiffed: construction material <br /> 5.3 Anticipated end use of incidental catnrnoditie(s) a be mirred : non e <br />llffice of (Hfwe of Caloodo <br />Mined land Reclamation Active acrd Inxtive Mlnes Geological Survey <br />P9 i <br />