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27 OCT 200312:05 <br />S~A~~ or- coLo~o <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sheonan R, Room 215 <br />Denver, Colorado 90203 <br />%ane: (303) 8663567 <br />FAX: (303) 8~ ~ ~~ ~, <br />OCT 2 9 2003 <br />CHECK ONE: <br />CONSTRIICflON MATE1tLsi'iS <br />LIlVJITEll II14I'ACT (110) OPERATION <br />RECLAMATION PEIt11IIT APPLICATION FORM <br />IJivision of Minerals ~n! Leo!c~~ <br />TLere is a File Number Aheady Assigned to thin Operation <br />DIVISION OF <br />MIN&RALS <br />GEOLOGY <br />RECLAMATION <br />MINING•aAFETY <br />Bill CT~em <br />Governor <br />Greg E. Waldkv <br />Executive Diretror <br />Ronald W. cwany <br />Permit # M O,~-~-5`t' (Please reference the Ste number currently assigtled to this operation) Acting Division Dirrctor <br />New Application (Rule 1.4.5) ~ Amendment Application (Ante 1.10) <br />Conversion Applicatan (Rrde 1.1 I) <br />Permit # Iv -a> e -_l~-,~ (provide for Amendmeota snd Convenioau of erdstmg permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Perrnit contains thrtx major paAs: (1) the <br />application farm; (2) Erdubirs A-7, Exhrbit I, Adtien&rm 1, any'soctions of Exhibit G.5 a~ Geotechoicd Stability Exhrbit, as required byl6e <br />Office, and otrtlincd in Rulcs G.l, G2, G.3, G.S, and 1.G.2(1)(b); and (3) the application fee. When you submit your application, be sore to <br />include one (I) com~rlctie signed and notarized IVORY ORIGINAL and one (1) copy of the completed IvO[~' application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fce dcu;rilred andcr (4) Iwlow. Exhibits shouts N~ be txntnd or in a 3-ring binder; maps should be foWul W 8 IR" X 1 I" or <br />8 1R" X 14" size. To expedite processing, please provide the information in the format sad order described in this form. <br />C'iEN111AI.OPERATiON INFORMATION <br />or print clearly, in the apace provided, ALL information described bebw. <br />1. Annlicantloperator or company name (name to be used oo Dermit]: ~oA'c~p /V I Je1144 r C ~ d° c~JIV'~ Y <br />1.1 Type oforganvwtion(corporation,partnership,efcJ: E%U.'Il~ei^ !'~(=rNT 2 <br />1.2 I.RS. Tax ID No. or Social SecarAy N <br />2. ODention name (Dlt, mine or site Dame): <br />3. Permitted acrea¢e (new or e:istioe site): <br />3.1 Change m acreage (+) <br />3.2 ToW Acreage in Permit Area <br />4. ~: <br />4.1 New Application: <br />Amendment Fee (C.RS. 34-32.5-125(II)): <br />4.2 Conversion Fix (from 1104 to 110 85C7s"00 twJlnversion fee (Auk 1.11.2(2)) <br />5. Primary commoditie(al to be mined: _ dI`1Nel ~~C~~ ~ <br />51.094.00 application fee <br />5719.00 application fee <br />5.1 Incidental cammoditie(sj to be mined: 1. / Ibs/fons/yr 2. / Ibs/Tonslvr 3. / lbsffons/vr <br />Jv~~M ~ - <br />a. i _ ms/I'onc/vr s. ' / m:rr~t.~/~r <br />5.2 Anticipated end use of primary commoditie(s) to be trained: ~ul ~ ~. ~ i ~)Q ~ /)~e r i ~ <br />Mticipated end use of incidental commoditie(s) [o be armed: __d/i E' T <br />_~_ permitted acres <br />.~1_ >~ <br />9- .aes <br />