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<br />STATE <br />DIVISION OF MINERALS AND GEOLOGY <br />DCp,vlmCnl pl N.tl Uro R2spu,CeS ~~ ~ ~ 1996 <br />I }1 1 Sherman Si., Hoom 215 •. <br />Dcnvrr, (•olurado H0207 <br />Ph nnc: I AI31 HG6-35L7 <br />f)~% 11031 H i'-H I OG D~IV1a140 AS MIPOtp10 i l:uoV:~i~y <br />CONSTRUCTION MATERIALS <br />REGULAR OPERATION (112) <br />RECLAMATION PERMIT APPLICATION FORM <br />~~~~ <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Gwemor <br />lames 5 Lo<hhcad <br />E,eaievc D~rc~lrn <br />N ¢ha a H. LunH <br />D iv ivon D~reaor <br />CHECK ONE: New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit ~ M - ~{' - \oJ3 -_ (provide for Amendments and Conversions of <br />existing permits) <br />The application for a Regular 112 Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical <br />Stability Exhibit; and (3) the application fee. When you submit your application, be sure to <br />include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed <br />ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 <br />(Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) <br />below. Exhibits should not be bound or in a 3-ring binder; maps should be fo).ded to 8 1/2" X 11" <br />or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and <br />order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly in the space provided the information requested below. <br />1 <br />(name to be used on permit): <br /> 1.1 Type of organization (corporation, partnership, etc.): C°~'t~OQs>`"rtoN <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: 8~'- ~~t2 4~ 2 <br />2. operation name (pit, mine or site name): "'l~H.~• AGr,~ cR•ELcP:CE ~ou~tG'E <br />3. Permitt ed acreaoe (new or existing site) ~i~ _ permitted acres <br /> 3.1 Change in acreage (+ or -) A' ~ O acres <br /> 3.2 Total acreage in Permit area \OC acres <br />4. Fees: <br /> 4.1 New Application 51,875.01) application fee <br /> 4.2 New Quarry Application 52,325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) 53,100.00 milling application <br /> 4.4/ Amendment Fee S1,550.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) 51,875.00 conversion fee <br /> Gd.-NnE CR.ANIT6 1L.vc'C ~,~,,t,y,nE,z <br />5. Primary commod it iefsl to be mined: A(.6R~lI'afl. R~Q-Ra.P Ge~rAJEA.. _ <br /> 5.1 Incidental commoditie(s) to be mined: 1. ~ lb~/Tons/yr <br /> 2. _ / lbs/Tons/vr 3. / lb:a/Tons/vr <br /> 4. / lbs/Tons/vr 5. / lb~a/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: g~a~o MAt~.••wi-S <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: _ " 1~ <br />