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. apny-a7,~ <br />RECEIVt1Ef/D <br />CONSTRUCTION MATERIALS ~ ~EC ~ 9 20(14 <br />REGULAR (112) OPERATION Division of Minerals and Geolepy <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a FR:e Number Already Assigned to this Operation <br />Permit # M -_ _ _ (Please reference the file number currently assigned to this operation) <br />g New Application(Ru]e1.4.5) ^AmeodmentApplication(Rule1.10) <br />Conversion Application (Rule I.] 1) <br />~Pertnit # _ _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 312 Operaton Reclamation Permit contains three major parts: (1) thti application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete simed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (Z) copies ofExlubi[s A-S, Addendum I, appropriate sections of6.5 (Geotechnica] Stability Exhibit, and acheck 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 I" or 8 12" X ]4" size. To expedite processing, please provide the information in the format and order descnbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested Below. <br />1. ApoDcant/operator or company name (name to be used on permit): Sit TRO JOINT VENTOBE, LLC / <br />1.1 Type of organization (corporntion, partnership, etc.): COLORADO LIPffTED LIABILIIR COMPANY <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br /> <br />Operation name /pi4 mi ne or site Hamel: LUPTON -LAKES RESOURCE <br />3. Permitted acreaeefneworexistinesite): <br />3.7 Change in acreage (+) <br />3.2 Total acreage in Permit azea <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 />3 61 permitted acres <br />aces <br />3 61 acres <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />$1.938.00 amendment fee <br />X2,344.00 conversion fee <br />5. Primary commoditie(s) to be mined: SAPID GRAVEL FILL MATERIAL <br />5.1 Incidental commoditie(s) to be mined: 1. N/A Ibs/I'ons/vr 2. / lbs/fons/vr <br />3. / Ibs/I'ons/vr 4. / Ibs/I'ons/vr 5. / Ibs/fons/vr <br />5.2 Anticipated end use of primary commodifie(s) to be mined: CONSTRUCTION MATERIALS <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br /> <br />