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<br />III IIIIIIIIIIIII III _TE of COLORADO <br />DIVISION OF MINERALS ANO GEOLOGY <br />Depanmem of Natural Resources <br />1 7 1 3 Sherman 5... Room ? 1 i <br />Denver, Colorado 80?03 <br />Phone: (3071 866-3567 CONSTRUCTION MATERIALS <br />FAX: (303) BJZ-aloe REGULAR (112) OPERATION <br />Rl'sCLAMATION PERMIT APPLICATION FORM <br />CF~CK ONE: There is a FDe Number Already Assigned to this Operation <br />Permit # M -_ __ _ (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.x) _ Amendment Application (Rule I.10) <br />Convesion Application (Rule 1.11) <br />Permit # M -~,'~-_~-_ (provide for Amendments and Conversions of existing permits) <br />~~ <br />D I VISION O <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />~MINING•g.>FETY <br />BJI Owens <br />Governor <br />Greg E Walther <br />Executive Direaor <br />Michael B. long <br />Division Direaor <br />The appbcation for a Construction Material Regulaz 112 Cperation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendtmm 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; a~ {3) the application fee. Whey you submit your <br />application, be sure to include one (t) covlolete sirmed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibit; A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to <br />8 112" X l l" m 8 I/2" X l4" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATTON ]INFORI4IATION <br />Type or print clearly, in the space provided, aD information described below. <br />1. AoADcant/ooeralor or comvanv name (name to be used on vermkl: <br />~A7 A~ G. FQ~rrw- <br />l.l Type of organization (corporation, partnership, etc.): 1!RRMErCS ~pdiS-tKuCf lnal X13, ,T Gr <br />1.2 I.R.S. Tax I.D. No. or Social St:curity Number: S7~n-//S P.S6 I <br />2. Oyeration name foil, mine or site name : o Ieason )ql -1' <br />3. Permitted acreatte (new or eiistintt site : ~_ permitted acres <br />3.1 Change in acreage (+) RECEI VEp -~~ g~ saes <br />3.2 Total acreage in Permit area 3 . ~ acres <br />MAY 0 9 2001 <br />4. Fees: <br />Division of Minerals and Geology 52.344.00 application fee <br />4.1 New Application <br />4.2 New Quarry Application $2,906.00 quarty application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (sct byAStaNte) '/ $2.344.00 conversion fee <br />$. Primary commoditie(s) to be mined: He gfron Y <br />5.1 Incidental commoditie(s)tobe:mw"edTT:rlrrJldrr mhr ~Artlbs/1(ort~/yr 2. / Ibs/I'ons/vr 3. / Ibs/fovs/vr <br />4. / Ibs/fons/vr 5. / Ibs/fons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: 1 <br />5.3 Anticipated end use of incidentrl commoditie(s) to be rained: ~O~fi~~l~i f/1 ~e LL ~66trA~~ <br />