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s f ~~ ~ ~~S `~` ~M -0 I ~' o Aac 8? os D <br />~~~ HARD ROCK/METAL MINING v' Mtr,rn9 a~y cJamatio <br />REGULAR OPERATION (112) Safety "• <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECKONE: ~ NewApplication(Rule 1.4.5) ~_ Amendment Application(Rule 1.10) _ ConversionApplication(Rule 1.11) <br />Permit # M-_ ~ ~ - '1~z ~L ~~- (provide for amendments and conversions of misting permits) <br />The application for a Regulaz Operation Reclamation Permit contains throe rrmjorpans: {I) the application form; (2) ExlnbitsA-S, Geotechnical Stability Exhibit <br />and Addendum l; end, (3) the application fee. When you submit your application, be sure to include one (1) completed, signed and notarized gray original and <br />four (4) copies of the completed applicafion form, five {5) copies of Exhibits A-S sad the Geotechnical Stability Exhibit, aadAddendtun 1, end a check for the <br />epplicaHon fee described order Section 4 below. Exhibits should NOT be bound or in a 3-ring border, maps should be folded ro 8 2" X 11" or 8 2" X 14"size. <br />To expedite processigg, p]tase provide the information in the format mid order described is Ibis farm <br />GENERAL OPERATION INFORMATION <br />Type or print efearly, in the space provided, ail Information described below. <br />1. ApplicanUoperatorname: /~r•eirJenfa.( Oi/ S'hale y J-hG. lip <br />I,1 Type of organization (corporation, partnership, etc.): Si~tce r ., re+e <br />1.2 I.RS. Tax I.D. No.: 95 - ZS (o St 9 ~3 <br />2. Operatiooname(pit,mineor5ltename): Laoan Waeln Mine. <br />3. Permitted acreage (new or existing site): 1 t 0 4o petffittedacres <br />3.1 Change in acreage (+ or -) <br />3.2 Total aaeage in Permit area <br />4, Fees: <br />4.1 <br />4.2 <br />4.3 <br />4.4 <br />4.5 <br />New Application <br />New Quarry Application <br />Milling Application (Non-DMO) <br />Amendment Fee <br />Conversion to 112 operation (set by statute) <br />.V/A saes <br />!r o~Fo saes <br />$1.875.00 application fee <br />$2.325.00 gtuury application <br />$3.100.00 milling application <br />$1.SSD.00 amendment fee <br />$1.500.00 conversion fee <br />5. Primary commoditie(s) to bemired: -fti-fi4- O i ~ G G~Ct,~g--~ <br />6. Name of owner of surface of affected land: ,~~..- ~a F Aibi->• D <br />7. Name of owner of subsurface rights of affected land: S'amo n a r, bn ve~f~ r ~Fa EXIn i b i t O <br />If 2 or more owners, refer to Exhibit O. <br />S. Type of mining operation: Sttrface x Underground <br />9. Location Intormation: the center of the azea where the majority of mining will occur li <br />cis <br /> COUNTY: CgG1~~L'lf~ <br />PRINCIPAL MERIDIAN (check one): _~ 6th (Colorado) _ 10th (New Mexico) <br />SECTION (write number): S 25 <br />TOWNSHIP (write number and check duection): T ~_ _ North _ CZ Sonth <br />RANGE (write number and check direction): R ~~ _ East ~_ West <br />QUARTER SECTION (check one): _ NE ~ NW _ SE ~_ S W <br />QUARTER/QUARTER SECTION (check one): _ NE NW _~_ SE SW <br />GENERAL DESCRIPTION (miles and direction from neazest town and approximate elevation):_~yL <br />Ute <br />In-situ <br />a.notee. rnea-n serer rover ramsl J, ^- to mtt<s ~t,Q 7's't+• DUVI aceess~#ood who>e.- <br />errtr'ur.ce. is 5 wti les no~~F/1 0~ Dc Ber$ixa.. , Colora5(o ts(>; 04 Ca 'Rpad 26~F• <br />