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/'l~lbh ~ <br /> STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />7 313 Sherman SL, Room 27 5 C O L D RA D O <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS RECEIVED MINERAL S <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8706 REGULAR (112) OPERATION <br />MAY 19 2004 ~ G E O L O G Y <br /> RECLAMATION PERMIT APPLICATION FORM RECLAMATION•NINING <br /> SAf ETY•SQ ENCE <br />Division of Minerals & Geology <br />Bitl Owens <br />CI~.CK ONE: There is a File Number Already Assigned to this Operation Governor <br />Greg E. Walther <br />Permit # M -_ _ _- _ (Please reference the file number cutrendy assigned to this operation) Executive Director <br />New Application (Rule 1.4.5) ~ Amen nt Application (Rule 1.10) Ronald w. canany <br />_ Conversion Application (Rule 1.11) Division Director <br />Natural Resource Trustee <br />Permit # M -.~_-2 05 -,_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (])the application form; <br />(2) Exhibits A-S, Addendum 1, any sections ofExhibit 6.5 (Geotechnical Stability E:dtibit and (3) [he application fee. When you submilyour <br />application, be sure to include one (1) complete sieved and notarized IV ORY ORIGINAL and one (1) copy ofthe completed h~o_rv applicatiun <br />form, hvo (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical 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 812" X 11"or 812" X <br />14" size. To expedite processing, please provide the infomtation m the foanat and order described in [his form. ,~ yl„ <br />Type or print clearly, in the space provided, .ILL information requested below. <br />. ~J <br />L AooiScanUouerator or rnmoanv name (name to be used on oermitl: DLO PAS'(LE ~ l't1 GROU Pr~'N e. <br />l .1 Type of organization (corporation, partnership, etc.): C(~XL ~ 1 N 1 ~E l~ ~Ill'N P~ N l F.5 nF t14ESA Cat 1 Sv!'(y <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: _~i y ~ ny yq 5310 <br />r <br />2. Oneration name lnit, mine or site name): (. HAt114 E 12 S ~ 1 T <br />3. Perrultted acreaee (new or eaistin¢ sRel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />45 Conversion to ] 12 operation (set by statute) <br />5. Priman~rnmmoaitie(s)tobemined; SAND C7aayf.L <br />5.1 Incidental commoditie(s) to be mined: ]. - IbslTonshT <br />3. 1 IbslTons/~7 4. / ]bslfonslyT <br />~ 1 q . ~ ' permitted acres <br />52. (~ acres <br />~ 7 2• ~ acres <br /> <br />$2344.00 application fee <br />$2906.00 quam' application <br />$1.938.00 amendment fee <br />$2,344.00 conversion fee <br />2. ! lbsffonsWr <br />~. ! Ibs/Tonsivr <br />5.2 Anticipated end use of primary commoditie(s) to he mined: P70~ 1] SASE ~ SPN A LT C ~N ('R FTF <br />5.3 Anticipated end use of incidental wmmoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />