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~~J / l'j~~ ~~~f'S61? / // ry G <br />STATE OF COLOIZAUO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources RECEIVE D <br />1313 Sherman St., Room 215 <br />Denver, Colorado 802D3 D I V I S I O N O F <br />Phone: (303) 866-3567 JAN 17 2003 ^~ M I N E RA L S <br />FAX: (3031 832-8706 & <br />Givision of Minerals and Geology G E O L O G Y <br />0.ECLAMATIO N <br />MININ G'SA FETY <br />REGQLAR (112d) DESIGNATED MINING OPERATION BillOwens <br />RECLAMATION PERMIT Governor <br />Greg E. Walther <br />APPLICATION FORM Executive Director <br />Michael B. Long <br />Division Director <br />CHECK ONE: New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit No. M-~- 3~/2_ (provide for amendments and conversions of existing <br />permits) <br />The application for a Regular (112d) Designated Mining Operation Reclamation Permit <br />contains three major parts: (1) the application form; (2) Exhibits A-T, Geotechnical <br />Stability Exhibit, the Emergency Response Plan, and Addendum 1, as required by the Office, <br />and outlined in Rules 6.1, 6.2, 6.3, 6.4.19, 6.5, 8.0, and 1:6.2(1)(b); and, (3) the <br />application fee. When you submit your application, be sure to include one (1) signed and <br />notarized Gray original and four (4) copies of the application form, five (5) copies of <br />Exhibits A-T, Rule 6.5 Geotechnical Stability Exhibit, the Emergency Response Plan, <br />Addendum 1, and a check for the appropriate application fee (described under Section (4) <br />on Page 2). Exhibits should not be bound or in a 3-ring binders; maps should be folded <br />to 8 'fi" X 11" or 8 '~" X 14" size. To expedite processing, please provide the information <br />in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />1. Applicant/operator or company name (name to be used on permit): <br />1.1 Type of organization (corporation, partnership, etc.): (.a/fJoe•zi~v~a'~ <br />1.2 I.R.S. Tax ID No. or Social Security Num1ber:p /ZJ'~ ~«~'~~/i' <br />2. Operation name (pit, mine or site name) : C7~~4-t°%'S~a /y~I'KE +~ /1`(%~~ <br />3. Permitted acreage: (new or existing site) 35 ~5~7 permitted acres <br />3.1 Change in acreage (+} -r~ acres <br />3.2 Total acreage in Permit area ~~ ~~ acres <br />