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<br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />RECEIa/E® <br />7 313 Sherman St., Room 22 5 MAR 2 2 2004 <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS <br />Phone: (303) 8663567 <br />FAX: (303) 832-8106 REGULAR (112) OPERATION pivisianq{~ipr~l~ag <br />RECLAMATION PERMIT APPLICATION FOR <br />M 8 2004 <br />CI-IECK ONE: There is a Fik Number Already Assigned. to this Operation <br />Oi sion of Minerals end Geology <br />Permit # M -_ _-_ (Please reference the file number currently assigned to this operation) <br />_ New Application (Rule 1.4.5) _ Amendment Application (Rule L 10) <br />X Conversion Application (Rule 1.11) <br />Perini[ # M - 19 _ 98 _ 052 (provide For Amendments and Conversions of existing permits) <br />COLORADO <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />0.ECLA MATION•MINING <br />SAFETT•SCIENCE <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cottony <br />Division DImCIOr <br />Natural Resource Trustee <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 ofExhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submityour <br />application, be swe to include one (1) wmDlete signed and notarized IVORY ORIGINAL and one (1) copy ofthe completes horv application <br />form, two (2) espies of Exhibits A-S, Addendtun 1, appropriate sections of 6.5 (t aeotechnical Stability Exhibit, and a check for the application <br />fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1 /2" X 11" or 81/2" X <br />14" size. 1'o expedite processing, please provide the information in the forma[ and order described in this form. <br />GENERAL OPERA'T'ION INFORMATION <br />Type or print ckady, in the space provided, ALL information requested bebw. <br />1. A~In6cantloneratororcomnaovnamefnametobeusedonoermit): Everist Materials. LLC <br />l .l Type of organization (corporation, partnership, etc.): LLC <br />1.2 LR.S. Tax LD. No. or Social Security Number: <br />2. Onerationnamefait"mineoraitenamel: Everist Materials Mascot Placer <br />3. Permitted acreage (sew or eaiaNng site): ~ • 9 permitted acres <br />3.1 Change in acreage (+) 79 ' ~ acres <br />3.2 Total acreage m Permit area 89 .0 acres <br />4. Fees <br />4.1 New Application $2 344.00 application fee <br />4.2 New Quarry Application $2906.00 quarry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 wnversion fee <br />5. Prim ancommoditiefs)tobemined: srraen r ock ~abinn road hasp sand gravel <br />5.1 Incidental commoditie(s) to be mined: I. - IbslTons%r 2. ! Ibs/Tonshr <br /> 3. / ]bs/Tons/vr 4. / Ibs/TonshT 5. / IbslCons/vr <br />5.2 Anticipated end use of primary commodi[ie(s)tobemined: construction materials <br />5.3 Anticipated end use of incidental wmmoditie(s) to be mined: <br />Office of <br />Mined Land Reclamation <br />STATE OF COLORADO <br />Active and Inactive Mines <br />Colorado <br />Geological Survey <br />