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STATE OF COLORADO <br />DIYi510N OF RECLAMATION, MINING AND SAFELY <br />Department. of Nafu.a Resources <br />13 73 Sherman St, Room .$ l i C O L D ft A D O <br />Denver, Colorado 80203 n t v ~ s I o N o f <br />Phones (303} 866-3567 CONSTRUCTION NIA'fF.RiALS RECLAMATION <br />FA%: l.303i 832-8106 RF,GULAR (172) OPERATION MEN [NCr <br />- &- <br /> RECLANiAT10NPERMT'f.1PPLICATION FORM SAFETY <br />6111 Owens <br />Governor <br />C}IECK O~i$: ~ There is a Fiic Number Already Assigned fo this Operxfion ausser Genrge <br />Permit N M -~ ~~ (Please reference the file number currently assigned to this opemfic5ft}""" D1eCOr <br />Ronald W. Clltany <br />New Application (Rule 1,4,5) _~ Amendment Application (Rule 1.10) owlsion olrccmr <br />___ Conversion Application (Rule 1.1 l) ham.ai Resource Tr„"~ ry, <br />Permit fl hl -2(J00 -OJO (provide for Amelldnfenfs and Conversions of exis-[ing pernvts) <br />The application for a Construction Nfaterials Regu]ar 112 Opern[ion Reclamation Peanit conlnins Ihree major parts: (1) the application <br />form; (2) Exhibits A-S, Addendwn 1, mty sections of Exhibit G.5 (Geotcchnical Stability Exhibit; and (3) the application fee. 6Vhen you <br />submit your application, he sure to include one (]) cotnnlete sianed and notarized ORIGINAL and one {I) copy of the completed <br />application fotm, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stabi]ity Exhibit, and a check fur <br />[he application fee described under Section (4) below. Exhibits should NOT be bound or iu a 3-ring binder; maps should be folded to <br />8 lit" X 1 I" or 8 V2" X 14"size. 'I'o expedite processing, please provide dte infomtntion in the format and order described ur this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALI infnrmatioa requested below. <br />1. :lnplieantlanerator or comnanv name (name to be rased oft eU rn»tt: ~('ms127?=t3~'1~$1Cs._._______ _ <br />1.1 `Cype of organization (corporation, partnership, etc.): __gg~~t~r., <br />2. Oncratimt name (nit. mhte or site name): AQ[1 I%D C~'dV21 Pit <br />3. Permitted acrcaee (new or esistine sitet: <br />3.1 Chnnge in acreage (~i.l <br />3.2 Total acreage in Pemtit area <br />4. Fees: <br />4.1 New slpplicarion <br />4.2 New Qaarry Application <br />4,4 Amendmeut Fee <br />4.5 Conversion to l 12 operatim7 (set by statute) <br />5. Frimarv commoditie(s) [o be mined: ___QE'dVP1 ~YY~tPS~ <br />5.I tnu~fental <br />~..~~ r~cipate <br />HgS~~,.3 Anl~i•.ipate <br />O:.I`: <br />~~ ~ <br />) cw <br />~' ~- <br />0 <br />0 <br />fo be mined: 1. N[A_.,______,__.___ 4@s('{;pnsl <br />76.27 u- permitted acres <br />~___ acres <br />156.27 acres <br />_2.344.00 _ application fee <br />~901_OU quarcy application <br />~t229.00 ~tH34BfT. amendment fee <br />_$2 344.00 , conversion fee <br />~ --_~ ___._. .._~i19)~1~ORa <br />Ibs/Tons/vr d. / Ibs/1'rns/yT i. Ibs/'lbns/vr <br />of primary cemmoditie(s) to be mined: il~fllP~ESEty OQL4trtrll7Ct11S1 _~___-- __-_.._- <br />tse of incidental commoditie(s) to he mined: <br />Olfire of Office of <br />0.ained land Retlama[lo° _ Active and Inactive mfine> <br />