REV100619

• Permit No: M2003092
• IBM Index Class Name: Revision
• Doc Date: 10/12/2005
• Doc Name: Reclamation Permit Application Form
• From: Nick H. Gray
• To: DMG
• Media Type: D
• Archive: No

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2. The Board may suspend or revoke this pamil, or assess a civil penalty, upon a finding that the pemtittee violated
the tams or condgians of this permit, the Act, the Mineral Rules and Regulations, or that intonnation mntairted inthe
application err your permit misrepresent important material facts;
3. If your mining and roclamatan operations affect areas bryond the boundaries of an approved permit boundary,
substantial civil penalties, to yet as permittee can result;
4. Arry modification to the approval muting and reclamation plan from those described in yore approved
application requires you to submit a permit modification and obtain approval from the Board or Office;
5. It is your responsibility to rtotify the Office of any changes in yroar address or phone numbs;
6. Upon permit issuance and prior to beginning on-site mining activity, you must post a sign at the entrance of flte
mine site, whidt shall be clearly visible horn the access road, with the following information {Rule 3.1.12):
a. the Havre of the operator;
b. a s[ateatan that a reclamation permit for the operation has boat issued by the Coorado Mined Lard
Reclamation Board; end,
c. the permit number.
~~'~ 7. The boundaries of the permit boundary area must be marked by momanents or other markers that are clearly
visible and adequate to delineate such boundaries prim to site disturbance.
8. It is a prrn~sicrt of this permit that the operations wiU be cwndtttaed le accordance with the tams and co~itions
listed in your application, as well as with the provisions of the Act and the Constntdion Material Rules and Regulffiias
in efferA at the time the permit is issued.
9. Annually, on the anniversary dateof permit issuance, you wtct submit an annual fee as specified by Statute, std
ao annual report which includes a map describing the acreage affected and the acreage reclaimed to date (i[ there are
changes from rim previous year), arty monitoring required by the Redatttation Pint to be submitted avmtaliy on the
emtiversary date of the pemtit approval. Amtual fees are for the previous year a permit a held. For example, a permit
with the anniversary date of July 1, 1995, the amoral fce is for the period of July 1, 1994 through June 30, 1945.
Faihae m submit yore anmrat fee acd report by the permit anniversarydale may result is a civil penally, revocation of
your permit, and forfeiture of your financial warranty. It is your responsibility, as the pamittee, tocooumte topayyour
annual fa to the Office until the Hoard releases yvu fiom your total reclamation responsibility.
10. For joint yen biaorrera[errs:thesigningrepreseotativeWautharizedtosigntltisdaatrvemandapotva
of attorney (provided by the periner(s)) authorizutg the sigmuue of the representative is attached to this application
Prxmit Coaditioa:
A reportable spill is a spill of atry toxic or hazardous substance (ira;luding spills ofpetrolann products) vvithm the
mined land permit area reportable to arty Division of the Colorado Departmatt of Public Health and the Environment, the
National Response Cemer, the Colorado Emergency Plarmiag Cormnission, arty local Earergcecy Planting Commission,
local Emergercy Planning Covrmittee, a the Stan Oil btspector. The Miffi Opaatar shall edify theDivisionof Miraals
mtd Geology (DMG) of a reportable spill within the mined land permit area using the ware timeftame required by the
permit, license, notice, statute, rule or regulation governing fhe reporting of the spill to the other appropriate agency.
Notioe of a reporable spill shall be FAXed to: Minerals Program Supervisor, Division of Minerals end Geology,
FAX [phone]. The FAX shall u~lude a call-back number of a responsible company official farDMG slaffmtcse
as a cantaa.