2003-10-29_REVISION - M1987092

• Permit No: M1987092
• IBM Index Class Name: Revision
• Doc Date: 10/29/2003
• Doc Name: Amendment Application
• From: Jordan C. and Jone L. Burdick
• To: DMG
• Type & Sequence: AM1
• Media Type: D
• Archive: No

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-DIWSIUN O{ 7y11NERAES AND GEOEOGY
~".~• : ~Depattmetn}otNafpRroal~Revdslo5urcei
Denver, ~
Phone: [phone]
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Ol~_COLORADO
CONSTRUCTION MATERIALS
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OCT 2 y 2003
DIVISION O:
MINERALS
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GEOLOGI
J~ ~` ~d /~ LIIVILTED IMPACT (110) OPERA'1'I(jlll'n of 6linera!s and Gsolc-'
~`~ ~ `~ ~~ s ^ ~+~~CLAMATION PERMIT APPLICATION FORM
CHECK ONE: / There b a FUe Number Already Aeeigtred to this Operation
eia opera
rotivnw
Greg E. Walther
Executive Dlnxar
Ronald W. Cattany
Permit # 110,E-~-~ (Please reference the file n~ber currently assigned to this operation) Acting oivlsion Diiecto
New Application (Ruk 1.4.5) _~ Amendment Application (Rn1e 1.10)
Convenbn Applica~on (Rule 1.11)
Permit # ~_~~-,~ (provide fm Ameodmmta and Conveniow of eidgting permits)
yn-14g?- t~ta
The applicstion fm a Construction MateriaLa Limited Lnpact (110) Operation Reclamation Permit ~ Onx major pmts: (1) the
application form; (2) Exhibits A-J, Exhibit L, Addendum 1, sny sectors of Exhibit 6.5 and Geotechnical ShbLlity Exhibit, as required by the
Office, sad otttlioed in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the spplioation fa. QV6rn yon sobmit your application, be sure to
inchau: one (I) complete sigced and notar¢ed IVORY ORIGINAL and cue (I) copy of the txtmpk:ted I3~ application form, two (2) copies
of Exhibits A-J, Exhbit L, Addendum 1, and appropriate sections of 6.5 ((leMechnical Stability Exhbit), ac required, and a check for the
application fee described under (4) below. Exhibits should IYOT be bound or ins 3-ring binder, traps should be folded to R 112" X L 1" or
8 1/2" X 14" sin. To expedite processing, please provide the information in the format end order desenbed in this form.
GENERAL OPERATION INFORMATION
Type or print ckarly, In the eprce pnwlded, ALL Inf t n d s be b ~ ~, , ~ P-[~j C'1
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1. AoDBcaotlooerator or com~y name (name to be used oD Dermit):
1.1 Type of organization (corporation, partnership, etc.): ~ U,'Ner n~ei-Rr R
I.2 I.RS. Tax m No. or Social Security Number 2.: ~ .~.j - y~ - tS' I y~
2. Operation name (nit. mine or site Dame): cc T ~" /
3. Permitted acreage (new or eiistina site) .Q ~ U -. -LQ~t-~ ~_ permitted acres
3.1 Change in acreage (+) ~ • 9 aaea
3.2 Total Acreage in Permit Area 9~ acres
4. ~:
4.1 New Application: 51.094.00 applieatioa fce
Amendment Fce (C.RS. 34-32.5-125(IT)): 5719.00 application fee
4.2 Conversion Fce (from 1104 to 110 R~`75.00 conversion fee (Rate 1.11.2(2))
5. Primary oommoditie(el to be muted: d /`lI(l of C/~~~~
S.1 Incidental commoditie(s) to he miuzd: 1. _ / lbs/Too„~/yr 2. / Ibs/fons/vr 3. / Ibs/Tons/vr
/yo~t1 e --
4. _ ! ]bsffons/~ S. _ ~ / Y Ibs/ions/vr
5.2 Anticipated end use of primmy commoditie(s) to be mined: _ Ljtl ! j..~ t AIR /N /)YE' i' I ~
An4cipated end use of incidental commoditie(s) to be mined: _,__ N~/V E'
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