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~ _ ~ RECEIVED pF~ RHG III'll'I~I~~~~~~ ~~~ 2 ) SEP 1 ~ 1995 OFF/V (F~q } 999 -- ~` ..rr1,1C•3iTION FORM ~~~~,~,~~ nn ~(~ CHHCK ONH: New Application (Rule 1.4.5) Amend~fEii>'.OApplicdtionG R leY1.10) X Conversion Application (Rule 1.11) Permit No. M- 90 _ 025 (provide for amendments and conversions of existing permits) The application for a Regular Operation Reclamation Permit contains three major parts: I1) the application form; (2) Hxhibite A-S and Geotechnical Stability Hxhibit; and, (3) the application fee. When you submit your application, be sure to include one (1) signed and notarized original and four (4) copies of the application form, five (5) copies of Hxhibite A-R and any required sections of Hxhibit S and the Geotechnical Stability Hxhibit, and a check for the application fee described under Section (16) on Page 3. Hxhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 i/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. --------- ---------------------------------------- _______________________________________________ GRNHRAL OPHRATION INFORMATION Type or print clearly, in the apace provided, all information described below. 1. Applicant/operator or companyy name (name to be used on permit): BLASTING AND MINING, INC. (dba Haycamp Gravel Co.) 1.1 Type of organization (corporation, partnership, etc.): corporation 1.2 I.R.S. Tax ID No. or Social Security Number: 2. Operation. name (pit, mine or site name): GARDNER PIT N0. 2a 3. Permitted acreage (new or existing site) 9.9 permitted acres 3.1 Change in acreage (+ or -) acres 3.2 Total acreage in Permit area acres 4. Fees: 4.1 New Application 51.875.00 application fee 4.2 New Quarry Application 52,325.00 quarry application 4.3 Milling Application (NOD-DMO) 53.100.00 milling application 4.4 Amendment Fee S1.550.00 amendment fee 4.5 Conversion to 112 operation (set by statute) 51,500.00 conversion fee 5. Primary commoditie(s) to be mined: GRAVEL 6. Name of owner of surface of affected land: LM[9 PROPERTIES 7. Name of owner of subsurface rights of affected land: LMN PROPERTIES If 2 or more owners, refer to Hxhibit O. 8. Type of mining operation: X Surface IInderground In-situ 9. Location Information: the center of the area where the majority of. mining will occur lies in: MONTEZUMA COLRiTY : PRINCIPAL MBRIDIAN (check one): _ 6th (Colorado) X 10th (New Mexico) _ IIte SHCTION (write number): S X North South TOWNSHIP (write number and check direction): T _ RANCH (write number and check direction): R Hast ~_ West QIIARTHR SHCTION (check one): _ NH X NW SH _ SW QIIARTHR/QIIARTHR SHCTION (check one): NH NW g SS SW GHNHRAL DESCRIPTION (miles and direction from nearest town and approximate elevation): ORIGINAL