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STATE OF COLORAi.DO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department ut Nature! Reuurces <br />1373 Sherman St.. Room ?15 <br />Denver <br />Colorado 80203 C O L O R A D O <br />, <br />Phone: (303) 866-3561 n t V i 5 7 0 N O f <br />RECLAMATION <br />Fax: t3o3) 832-at oe MIN 1 N G <br /> -Sr- <br /> SAFETY <br /> CONSTRtiCTION MATERIAL Y <br /> LIMfCF.ll IMPACT (I10) OPERATION sin rn°e"` <br /> Governor <br /> RECLAhIATION PERMIT APPLICATION FORM Rmval Grnrgc <br /> 4eautivc Dirmor <br /> Rowld W. Cattany <br />CfiECiC ONE: "Cherc is a File Number Already Assigned to this Operation Dlvswn D}re¢tor <br /> Natural Resource Tru4ee <br />Petn»t # M -_ ; , (Please reference the file number curzently assigned to this operation) <br /> <br /> New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) <br /> Conversion Application (Rule 1.11) <br />Petmit It ~'[ -!_ __ __ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Tmpxet (110) Operation Reclamation Permit contnins three major parts: (I }the <br />application form; (2) Exhibits A-1-, F..xhibit i., Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(I)(b); and (3) the application fee. Whetr you submit your application, be <br />sure to include one (I) corr~r lete sinned and notarized ORIGINAL and one (t) copy ofthe completed application form, two (2) copies <br />of Exhibits A-1, Exhibit L, Addendum I, and appropriate sectiots of6.5 (Geatechnical Stability Exhibit), as required, and a check Far <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X <br />I t" or 8 U2" k 14" size. Ta expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, itt [he space provided, ALL iafortnatioo described below. <br />I . Aonlicanyooerator or comoanv name (name to be used on Iaermttl: ~~ ~~ ~,~,~ I e, <br />1.1 Type of organization (corporation, partnership, etc.): X1'1 r11f10 t4~11 l ~ __ <br />2. Operation name (pit, mine or site name): ~,Q (~ ~ J 1)f,11~~ ('(~ <br />3. Permitted acreage (new or existing site): 1 _ permitted acres <br />3.1 C7tange in acreage ({) acres <br />3.2 'total Acreage in Permit Area ~~ acres <br />4. Fees: <br />4.1 New Application: ~ t Q9~t,U0 application fee <br />Amendment Pee (C. R. S. 34-32.5-125(11)): A Lt~.tV QCj _ $719 00 applicatian fte <br />4.2 Conversion Pee (from 1 IOd to 110~75A0 conversion fee (Kole Ll L2(2}) <br />5. Primarvcommoditie(sltobemined:~.y~~ r >~. ~~~lYe.(,(~~t (~YLlye~i ~()~~j <br />5.1 Incidental commodities} to be minbtY. ~'w` ! ~I IbslT'atsivr 2. _ ( Ibsf('ons/xr 3. __ ! ~1 tbs!'CanS/vr <br />4. __ / Ibs~Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />Anticipated end use of incidental commoditie(s) to be mined: <br />5. / Ihsffons~ <br />a $ IQn____r1xaT~ <br />r ~ d i~ ~~-r Ana r- <br />Off¢e of <br />MinCd land Rcclamatlon <br />pf(iCe of <br />Active and Inactive Mines <br />