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III IIIIIIIIIIIII III ~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY f~ <br />Depanment of Natural Resources -`: ~ I,'/~ <br />1111 Sherman Si., Room 275 Irr~ <br />Denver, Colorado 80203 _,1 II <br />Phone: (303) 866-3567 <br />FAX: (3031 832-8106 <br />Dlv~~.,,,~ ~~ „,~~~erals & Geology DEPARTMENT OF <br />NATURAL <br />CONSTAIICTION MATERIALS ~SQURCES <br />RSGQLAR (112 ) OPERATION Roy Romer <br />RSCLAMATION PERMIT APPLICATION FORM Governor <br />)amen 5. Lochhead <br />Execmive Diecor i <br />Michael B. Long <br />D~ms~on Director <br />CHECK ONE: X New Application (Rule 1.4.5) Ameadmeat Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # - -_ (provide for Ameadmeata and Converaioas of <br />existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete signed and notarized IVORY ORIGINAL and four (4) <br />copies of the completed Ivor application form, five (5) copies of Exhibits A-S, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br />described under Section (4) below. Exhibits should NOT be borLnd or in a 3-ring binder; maps <br />should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide <br />the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, is the apace provided, ALL information requested below. <br />---------------------------------------------------- ---------------------------------------- <br />1. Applicant/operator or comPaav acme (same to be used on Permit): <br />Mall Irwir, Construction Comoanv, Jeff Greg <br />1.1 Type of organization (corporation, partnership, etc.): rnrPnratinn <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: ail-O52.4D73 <br />2. operation name (pit, mine or site name): The Shores, Firestone, Colorado <br />3. Permitted acreage iaew or existing site): ?n~-R:1 permitted acres <br />3.1 Change in acreage (+ or -) acres <br />3.2 Total acreage in Permit area acres <br />4. Pees: <br />4.1 New Application 51,875.00 application fee <br />4.2 New Quarry Application 52,325.00 quarry application <br />4.3 Milling Application (Non-DMO) $3,100.00 milling application <br />4.4 Amendment Fee 51,550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 51,875.00 conversion fee <br />5. Primary commoditie(s) to be mined: canri ", aravPl <br />5.1 Incidental commoditie(s) to be mined: 1. TOP SO 11 20,000 1bslTonslyz <br />2. / lbs/Tons/yr 3. / lbs/Tons/yr <br />4. / lbs/Tons/vr 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: COnstrUCtion materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: LdndscdPiilg <br />