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ONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M -_--_ (Please reference thefile number currently assigned to this operation) <br />New Application (Rule 1.4.5) % Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -1,QQ¢ 111 fi -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) [he application <br />form; (2) Exhibits A-S, Addendum ],any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure [o include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application forth, two (2} copies of Exhibits 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 1 /2" X 1 1" or 8 1 /2" X 14" size. To expedite processing, please provide the information in the forma[ and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. AoolicanUoperator or comnany name (name to be used on permitl: Lafarge West ~ InC. <br />1.1 Type of organization (corporation, parNership, etc.): Corporation <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. <br />3. <br />Operation name (pit, mine or site namel: Riverbei:td Operation <br />Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Sand Gravel Fill <br />5.] Incidental commoditie(s) [o be mined: 1. NA - Ibs/Tonslvr <br />437 permitted acres <br />931 acres <br />t , 3FR acres <br />$2.344.00 application fee <br />$2,906.00 quarry application <br />$1 938.00 amendment fee <br />$2,344.00 conversion fee <br />2. / lbs/Tons/vr <br />3. / lbsllons/yr 4. / Ibs/TonsA~r 5. / Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Construct lon Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: NA <br />