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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman SC, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />RECEIVED <br />SEP 0 3 2002 <br />Division of Minerals and Geology <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLA?\4ATION PERDIFP APPLICATION FORM <br />CHEC1; ONL-: Tbere is a Fr7e Number Already Assigned to this Operation <br />Pcrmit # M -~-~-_ (Please reference dte fileycumber currently assigned to this operation) <br />New Application (Rule 1.4.5) /~ Amendment Application (Rule 1. ]0) <br />Com~ersion Application (Rule i.l 1) <br />Permit # M -~ ~-_ (provide for Amendments and Conversions of existing permits) <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MININ G•SAFETY <br />Bill Owens <br />Governor <br />Greg E. VJalcher <br />Executive Diredo: <br />Ronald K'. Cattany <br />Acting Division Director <br />The application for a Conshuction Materials Regular 112 Operation Reclamation Permit contains three major parLS: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) HIe application fee. When you submit your <br />application, be sure to include one (1) complete siffied and notarized NORY ORIGINAL and one (1) copy of the completed I~ application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee descnbed tinder Section (4) below. Extdbits should NOT be bound or in a 3-ring binder; maps should be folded to 81/2" X 1 ]" or 8 1/2" <br />X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />(.;ENEItAI, OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />Type of organization (corporation, partnership, etc.): <br />3. Permitted acreage (new or ezistin¢ site); <br />3. ] Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Qnan'y Application <br />4.4 Amendment Fee <br />4.5 Cometsion to 112 operation (set by statute) <br />5. Primary conrntoditiels) to be mined: - -- <br />5.1 Incidental commoditie(s) to be mined: 1. ~~, (~Ibs, o~ii' t>4/a <br />3. / Ibs/Tonshr 4. <br />5.2 Anticipated end use of primary commoditie(s) to be mined: _ <br />permitted acres <br />acres <br />~n~ acres <br />$2.344.00 application fee <br />$2 90 gttatry application <br />$ ,938.00 amendment fee <br />0 conversion fee <br />2. / Ibs/Tons/yr <br />5. ! 1bs/Tonslvr <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />2. Operation name (oft, mine or site namel: ~t ~'1 Vl/~il/X~t (1 <br />