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RECEIVED ~ <br />13 NOU 200310:51 NOV 1 9 2003 <br />~ ~ - STATE OF~,~C~i~DO <br />DIVISION OF ERALS AN OLO <br />Department of Natural Resources /~~ - L ~ ~~,,,~~ ~q}y"'~{ o - ~ ~ ~ ~ ~ ~A~ <br />1313 Sherman"St ,Mtoorg~215 l~'~""- ~// °"~ <br />Denver CblbrddOso2dsU,.., - 01 v t s 1 o N t. ~, <br />Phone: (303) 866-3567 O C T 2 y 20Q3 MINERAL <br />f 1 /.;ONSTRUCITON MATERIALS & <br />~~~~~~ ~ GEOLOGI <br />`'°~ LIMITED 1MPACT (110) OPERATIdlil'° °t ft'OEfa'r and C°elr• R E C L A N Ar l O <br />`~~ ~~ ~`p l~/p/'A~~ NINING•SAf E1 <br />(~ L f-I !Y (y (d CLAMATION PERhIIT APPIICATION FOBM <br />stn owes <br />Goverrar <br />Gag E. Waldln <br />FxMaive Director <br />CHECK ONE: ' / There u a File Nmaber Already AaaiBaed to thin Opeaatbn ~~ w caaanr <br />Permit # M o"~i -~-~ (Please reference the Ste number currently assigned to this operation) A«~+a oiasion Direrta. <br />New Application (Rnle 1.4.5) ~_ Amendment Application (Bolo 1.10) <br />Caavenlon Application (Rule ].l l) <br />Permit # M ~1-,-,1~ (provide for AmendmeaU and Coaveniooa of eaosting peruaita) <br />yn-!4g?-t~Ia <br />The application for a Construction MakriaLs Limited Impact (110) Operation Reclamation Pamir contains thrtx major parts: (I) the <br />applicatoD form: (2) Fadibits A-J, Exhbit h, Addeudnm 1, any soclioos of Exhibit 6.5 sal Grata finical Stability E>dubil, as aoquirod by the <br />OlI•ax, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1 xb); and (3) tine application fee. When you submit your application, be sure to <br />include one (i) compl~lc sig~od acrd notarj~d IVORY ORIGINAL, and one (1) copy of lltc oolupleted IYe[V application form, two (2) copies <br />of Exhabits A-J, Exhtbit L, Addendum 1, and appropriate sections of 6.5 (Geo[echnical Stability Exhibit), as required, and a check for the <br />applcaton fee descnbed tinder (4) below. Exhibits should NnT be bound or in a 3-ring binder, maps should be folded to 8 12" X 11" or <br />8 12" X 14" size. To expedite processing, please parn~de the information m the format and order describal iu this form. <br /> rhiNl?RAI.OPf~RATION INFORMATION <br />Type or print clearly, is the apace provided, AI,I, iaf fit' n d be <br />~ , ~ (-~r ~ <br /> i <br />1. ~pD llCaat/ODeratOr Or COm Pant Oame tnanlC r0 be Ilaed Un nerallt): _ <br /> I.l TypcoforgaPV.atioP(wrpurataa,Parta~m3hip.c4:.): ~lti'NCi' c~Pt~t <br />-f7~~(i' <br /> 1.2 q <br />I.RS. Tax ID No. or Social Secur[ty Namber: 2.: ~ ~.3 - yvZ - 8 / ~~ <br /> ~ <br />2. Ope ration Dame (nit. anise or site iame): <br />, <br />3. Permitted acreat=e (new or esiatio aite : Q ~' ~~-~-P ~ L permitted acres <br /> 3.1 Change m acmage (+) ~ - 9 sacs <br /> 3.2 Total Acreage in Permit Area - 9i oars <br />4. ~: <br /> 4.1 New Application: 51.094.00 application fee <br /> Amendment Fee(C.RS.34-32.5-125(17)): 5719.00 applicationfeo~ <br /> 4.2 r <br />CoavasionFee(fiom110dto110 87 . cm <br />rve <br />sioafoe(ILukl.il.2(2)) <br /> t <br />~ <br />/ <br />~ <br />5. Pri mary commoditie(s) to be mired: ~ v <br />~ <br />5.h Incideotalcommoditie(s)tobemined: 1. f ]bsn'o sue/ r 2. 1 ibslfonslvr 3. / Ibs7fons/vr <br />/V~~M ~ 4 ~ / lbs(fons/vr 5. _ ' ! lbiis/Coashr -r- <br />5.2 Altticipated end use of primary commoditie(s) to be rlaiaed: 13' 4l i ~ d r t~l Q /~ t)rE' r' i ~ <br />Anticipated end use of incidental commoditie(s) to be mined: N~iV E' <br />