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<br />~ iii iiiiiiiiiiiiiiii <br />~T~~~, OF COLORADO <br />DIVISION OF MINERALS AND GEO-OGY <br />DCP.lrlmenl ul Ndlufll ResOUrCBS <br />111 S Sherman 51., Room ? I i <br />Denver, GiluraAu NU_?Ul <br />Vhune: (3031 OfiG-3.5 n: <br />FAx: 1J03)H32~nIDG <br />RECEIVED <br />`\~ <br />JAN 0 8 2001 <br />Division of Minerals and Geology <br />DIVISION O F I <br />MINERALS <br />St ! <br />GEOLOGY; <br />N E C L A M A T I O N~ <br />MINING•SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: ~(_ New Application (Rule 1.4.5) <br />Conversion Application (Rule I.I 1) <br />wn-oo( <br />Gill Owrns <br />Governiv <br />firer; E walcncr <br />Eaecvlrve D~renor <br />hchael e. Lonµ <br />Amendment Application (Rule 1.1 O~iwsion Dveaar <br />Permit # M --_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamazion Permit contains three major parts: (I) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit and (3) the applicazion fee. When you submit your <br />application, be sure to include one (1) comolete signed and notarized IVORY ORIGINAL and four (4) copies of the completed Ivy <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or N a 3-ring binder; maps should be folded to <br />8 I/2" X 11" or 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 print clearly, io the space provided, ALL information requested below. <br />L Aoolicantlooerator or comoaov name (Dame to be used o0 oermitl: our ~~"~S A~~~L~,J ] P <br />1.1 Type of organizarion (corporation, partnership, etc.): 1_trnt~d t ta~i~ ~'ht ~r.~ <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: ems-- 454-1 lrf <br />2. Operation Dame (nit. mine or site Hamel: <br />LIh1E CAMP ~lT <br />3. Permitted acreage (new or existioa sitel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarty Application <br />4.3 Milling Application (Non-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to I l2 operation (set by statute) <br />8,Q permitted acres <br />acres <br />acres <br />$1.875.00 application fee <br />S?.325.00 quarry application <br />53.100.00 milling application <br />$1.550.00 amendment fee <br />$1.875.00 conversion fee <br />5. Primary commoditiMsl to be mined: S71'~ ar>~ a~~ <br />5.1 Incidental commoditie(s) to be mined: I. Ibs/fons/vr 2. / Ibs/Tons/vr <br />3. ! Ibsffons/vr 4. 7 1bslTons/vr 5. 1 1bslfons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: CDf15tIUC.tiO(1 an~t'~a~P. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />