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F COLORADO <br />DIVISION OF MINERALS AND GEOLOGY a 7G V C 1 V C U <br />Department of Na[ural Resources <br />1313 Sherman St., Room 215 JAN 0 2 2003 <br />Denver, Colorado 80203 FILE COPY ~~ DIVISION O F <br />Phone: (303) 866-3567 C'F/~/~ MIN &RA L S <br />FAX: (303) 832-8106 /t A, ~Ji ~'sion of Minerals and Geology o f <br />fO~s4AN/Y~N(8 C16~ GEOLOGY <br />CONSTRUCTION MATEBIALS <br />REGULAR (112) OPERATION <br />Bfy~ • 002 RECLAMATION <br />0 MINING•SAFETY <br />! o gMjnera/s dod~ep/~,~II~ovrens <br />RECLAMATION PERMIT APPLICATION FORM db4emor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: There Ls a Ft7e Number Already Assigrted to this Operation Ronald w. Canany <br />Perini[ # M - 77 - 392__ (please reference [he file nmmber currently assigned to this operation) Act'ng Divl:ion Dtrecror <br />_ New Application (Rule 1.4.5) _~ Amendment Application (Rule 1.10) <br />_ Conversion Application (Rule I.1 I) <br />Permit # M - 7 7 - 39 2-_ (provide for Amendments and Conversions of existing permits) <br />The application for a Canstrwtion Materials Regular 112 Operation Reclamation Pemrit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendmm ],any sections of Exhrbii 6.5 (Geotwhnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sine to include one (1) complete sieved and notarized IVORY ORIGINAL and one (1) copy of the completed I~ application <br />form, two (2) copies of Exhibits A-S, Addendum 1, appropriate swoons of 6.5 (Geotwhnical Stability Exhibit, and a check for the application <br />fee de~n'bed under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder maps should be folded to 8 1/2^ X 11" ar 8 1/2" <br />X 14" size. To expedite processing, please provide the information in the format and order descnbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />c% <br />I. ADplleanUODeratOr Or COmranV name (name to be used On lrermltl: A~KI5XRS57tStiLltSd~XBY"l7sitl7! Tlcnv'~ar Rri rl~ !:n , <br />1.1 Type of orgaaiz~tion (corporation, partnership, etc.): <br />].2 I.R.S. Tax I.D. No. or Social Swutity Nmmber: ~! <br />2. Ooeration name lart, mine or site name): <br />3. Permitted acreagse (aew or esistino siiel: <br />3.1 Change in acreage (+) <br />3.2 Tota'. acrea?z v-t Pern'.it area <br />4. Fees: <br />4.1 New Application <br />4.2 New Qoarry Application <br />4.4 Amendment Fee <br />4S Conversion to 112 operation (set by statute) <br />~. Primary commodiiie(sl to be mixed: Clay <br />5.1 Incidental commoditie(s) [o be mined: 1. - Ibs/Tons(vr <br />3. / Ibs/Tonslvr 4. / lbs/I'ons/vr <br />35 pr uinzd acres <br />7.45 acres <br />49.35 acres <br />$2.344.00 application fw <br />$2 906.00 quarry application <br />31.938.00 amendmca fu <br />$2.344.00 conversion fee <br />2. / lbsffons/vt <br />5. / 1bsrTonshr <br />5.2 Anticipated end use ofptimarycommoditie(s)tobemined: Manufacturing Brick <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />