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II ~II~I~II~~~~~'I~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />De~anment of Natural Resources <br />1313 Sherman SI., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX (303) 8328106 <br />~~C~1V~D <br />CONSTAIICTION MATERIALS <br />REGQLAR (112) OPERATION <br />ATION PERMIT APPLICATION FORM SEP lfl 1997 <br />t/m~r-4~Mtnt ~pp~cgT'sM <br />U IJISIOn UI mtllQftli5 c: GeCIOg}~ <br />~" <br />~~~~~ <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Governor <br />lames 5. Lochhead <br />Eve<wive Director <br />Michael B. long <br />Drvivon Director <br />CHECK ONE: New Application (Rule 1.4.5) K Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - ~~• -~-~ (provide for Amendments and Conversions of <br />existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) Che application form; (2) Exhibits A-S, Addendum 1, any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete si4ned and notarized IVORY ORIGINAL and four (4) <br />copies of the completed Ivorv application form, five (5) copies of Exhibits A-S, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br />described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps <br />should be folded to 8 1/Z" X 11" or 8 1/2" X 14" size. To expedite processing, please provide <br />the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, is tha space provided, ALL information requested below. <br />--------------------------------------------------------------------------------------- <br />-------------------------------------------------------------------------------------- <br />1. Applicant/operator or company name (name to be used on permit): <br />GL-P GYP'SV.M l OC~POI7.fl.~-\OtJ <br />1.1 Type of organization (corporation, partnership, etc.): ~ottP. <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: _ -]4- ~l ~$~~' r <br />2. Operation name (pit, mine or site name): CoA{.DALT~ Q~AAW+(>;1f <br />3. Permitted acreage (new or existing site): \oo permitted acres <br />3 .1 Change in acreage (+ or -) -o acres <br />3. 2 Total acreage in Permit area ADO acres <br />4. Fees• <br />4. 1 New Application $1,875.00 application fee <br />4 .2 New Quarry Application $2,325.00 quarry application <br />4. 3 Milling Application (Non-DMO) 53,100.00 milling application <br />9. 4 Amendment Fee $1.550.00 amendment fee <br />4 .5 Conversion to 112 operation (set by statute) $1,875.00 conversion fee <br /> <br />5. Primar N~~ . <br />y comet dine(s) to be mined: p~iUF'~ <br />5. 1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr <br /> 2. / lbs/Tons/vr 3. ! lbslTOns/vr <br /> 4. / lbs/Tons/vr 5. / lbs/Tons/yr <br />5. 2 Anticipated end use of primary commoditie(s) to be mined: '~S p. <br />5. 3 Anticipated end use of incidental commoditie(s) to be mined: <br />