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~ ~I~CEI`~i~~ LIMITED IMPACT OPERATION (110(2)) • RECLAMATION PERMIT apR 2 3 1991 APPLICATION FORM Mine Land The application fora Limited Impact Operation Rec)amation Permit cp~t~l~fl,5,r~xe~;,maj~or parts: (1) the application form; (2) Exhibits A-J; and, (3) the app is on 'ffee. WFien you submit your application, be sure to include two (2) ~ssi~g~n,~ed originals of the application form, two (2) copies of Exhibits A-J, and a cnecK for the application fee described under (3) below. To expedite processing, please provide the information in the format and order described in this form.___--__-__-~,~ _ o ~_ n S 1____________________ ----------------------------------------------------------------------------------------- GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, all information described below. 1. Applicant/operator name: Del Rodarmel .. '1 .1 Type of organization (corporation, partnership, etc.): Individual 2. Operation name (pit, mine or site name) Florence Sand and Gravel Pit 2.1 I.R.S. Tax ID No. or Social Security No.: 3. Application fee for permitted acreage* 9.98 permitted acres (;25..00 + 10/acre)* Note permitted acreage and application fee and attach a check for this amount when you file. $875.00 application fee Substance(s) to be mined (e.g., gravel/gold/borrow): Sand and Gravel 5. Name of owner of surface of affected land: Del & Sheila Rodarmel 6. Name of owner of subsurface rights of affected land: Continental Oil Co. 7. Type of mining operation: XXXSurface _ Underground _ In-situ 8. Location information. The center of the area where the majority of mining will occur lies in: COUNTY: Fremont PRINCIPAL MERIDIAN (check one): 6th (Colorado) 10th (New Mexico) Ute - TOWNSHIP (write number and check dir~tion); T TJ North XX $outh RANGE (write number and check direction): R +TS i East XR` West SECTION (write number): S ~1` QUARTER SECTION (check one): 11E XXk~lW SE SW QUARTER/QUARTER SECTION (check one): '- NE ~RkM1W i' SE - SW GENERAL DESCRIPTION: (miles and direction Sub,iect lies in Florence City limits near south from nearest town and approximate elevation) boundary - Elevation_5250 an^_r oximately V * A fraction of an acre mist be counted as one acre for fee calculation, If the ~erator is a unit of state or county government, an application fee is not required.