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III IIIIIIII11111111 • <br />STATE OF, <br />DIVISION OF MINERALS AND GEOLOGY <br />Deparrmen[ of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: 13031 866-3567 <br />FAX: (3031 832.8106 <br />CONSTRUCTION MATERIALS <br />LI)NITED IIKPACT (110) OPERATION <br />AUG 2 3 2001 <br />Division of Minerals and <br />RECLAMATION PERMIT APPLICATION FORM <br />~~ <br />DIVISION Ok~ <br />MINERALS. <br />GEOLOGY <br />0. EC LAMATION <br />MI NING•SAFETY <br />Bill Owens <br />Governor <br />CHECK ONE: _ ` There is a File Number Already Assigned to this Operation <br />Greg E. Walther <br />Executive Director <br />Michael B. Long <br />Permit # M - 00 -~ _ (Please reference the file number currently assigned to this operation) D+~+s+on D.re<lor <br />New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) <br />Convenioa Application (Rule 1.11) <br />Petit # M -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (1IO) Operation Reclamation Petit contains three major parts: (I) the <br />application form; (2) Exhibits A-J, Exhtbtt L, Addendum 1, any sections of Exhibit 6.5 and Geotcehnical Stabiluy Exlubi[, as squired by the <br />Office, and outlined m Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fce. When yon submit your application, be sure to <br />include one (1) cumulate sued sod notar¢ed IVORY ORIGINAL and one (1) copy of the completed Ivat apphcation form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, end epptopriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described ceder (4) below. Exbibits should NOT be bound or in a 3-ring border, maps should be folded to 8 I/2" X 11" ar <br />8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or punt ckariy, in the space provided, ALL information described below. <br />1. AnnlicanUooerator or eomoanv name foame to be used on oermkl: <br />C~•~eY .Qil/OE,~L E ~o~sr~euGr/oc% ~~/~/,. <br />L l Type of organization (corporatio0. partnership, etc.): ~~/-DO/-"4 T7 D/) <br />1.2 I.RS. Tax ID No. or Social Security Ntrmber: 2.: ~~ l 20,5 7/Q <br />2. Ooeratioo name tort. mine or site name]: yPL~~~~ ~~~~'~~ <br />3. Permitted acrcaee tnew or esvetine ettel: ~ ~~ permitted acres <br />3.1 Change in acreage (+) <br />Tote! Acreage m Permit Area <br />4. Fees <br />~ acres <br />acres <br />4.1 New Application: S 1.094.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)): 5719.00 application fee <br />4.2 Conversion Fce (from I 1 Od to 110 8S 75.00 conversion fee (Role 1.11 <br />2(2)) <br /> <br />S. Prim <br />ary eommodinerel to be mined: /'Q~'C~ SQ~d ~i <br />/ <br />~[/ ~~ Co66~rs <br />5.1 Incidentilcommoditie(s)Wbemined: 1. ! Ibs/fonsJvr 2. ! {bslfonslvr 3. / lbs/Ions/vr <br /> <br /> 4. / Ibs/1'oos/vr 5. / Ibs/I'ons/vr <br /> <br />5.2 <br />Anticipated end use of primary commoditie(s) to be mined: <br />~OIL~ ,(~ILSC~ - ` <br />L ~~~SCCj~ e <br /> <br />Anticipated end use of incidental commoditie(s) to be mined: /VO/7 e <br />