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TATE OF <br />DIVISION OF MINERALS AND GEOLOGY /C ° f <br />Department of Natu21 Resources ®jr/app p j ~e' p <br />7373 Sherman St., Room 275 O ~~ <br />Denver, Colorado 90203 CONSTRUCTION MATERIALS~°I`E CO PprB/f apr <br />Phone: 1303) 8663567 ///~~~ /®p~/ppy /~pC©ep <br />FAX: (303) 832-9106 ~CLAMATION PE$Mfl' APPLICATIO~~~~' ° ° ° /° <br />CHECK ONE: There is a Fik Number Already Assigned to this Operation <br />RAD O <br />O N O F <br />RALS <br />GEOLOGY <br />RECLANATION•NINING <br />SAFETY•SCIENCE <br />Bill Owens <br />Governor <br />Permit # M -_ = lease reference the file number c7nren[I asst ed to this o eration tree E. watcher <br />(P }' ~ P ) Executive DlfeCtor <br />_, New Application (Rule 1.4.5) /Amendment Application (Rule 1.10) Rolald w. Camany <br />_ Conversion Application (Rule 1.11) Division Director <br />Natural Resource Trustee <br />Permit # M -~_- ~ y - f~(provide for Amendments and Conversions of existing permits) <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, airy sections of Exhibit 6S (Geotechnical Stability Exhibit; and (3) the application fee. When you submityour <br />application, be sore [o include one (1) complete simed and notarized IV ORY ORIGINAL and one (1) copy of the completed vory application <br />form, two (2) copies ofExhibits A-S, Addendum 1, appropriate sections of6.5 (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 8 lCL" X 11" or 81/2" X <br />14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apatt provided, ALL information requested bebw. <br />I. Aoolicant/ooentor or comoanvname (name to be used on cermit): SAu ~19 R~ ,JiPn/v ~ URfJ u E <br />1.1 Type of organization (corporation, partnership, etc.): s CSNL~ <br />1.2 I.RS. Tax I.D. No. or Social Security Number: p~i°- ~f: H/63 <br />2. Ooent'um name (nit, mine or site Hamel: Lr~it~Lifl Z <br />3. Permitted acnea¢e (new or ertiatin¢ afte): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />/~ permitted acres <br />lR•~/~/ acres <br />' ©r ~ acres <br />4. Fees <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarry Applieation $2 906.00 quarry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />45 Conversion to 112 operation (set by statute) $2344.00 conversion fee <br />//11 <br />5. Primary rnmmoditiefs) to be mined: r D Ir~AUr~L _~ <br />5.1 Incidental cormoditie(s) to be mined: 1. - Ibs/fonshT 2. / Ibs/Tons/vT <br /> 3. / lbs/Tons/vr 4. / ]bs/fonsh7 5. / lbs/Tons/vr <br />52 Anticipated end use of primary commoditie(s) to be mined: <br />53 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined land Reclamation - Active and Inactive Mines Geological Survey <br />