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~`r~"EiVED <br />JUN 0 ~ 2006 <br />Gn~.ion of MiootiF~~p Gaoloyp <br />f't'I-a~oo~-Gy7 <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M -_ _ _ (Please reference the file number currently assigned [o [his operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (I) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections ofExhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When you submit your application, be <br />sure to include one (I) comole[e signed and no[azized ORIGINAL and one (I) copy ofthe completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geo[echnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X <br />11" or 8 1/2" X 14" size. To expedite processing, please provide the information in [he fornat and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. ApplicanUooerator or company name (name to be used on mermitl: h t'~ l N~%3Cl t~ 1 i\ l~ A\'Y <br /> 1.1 Type of organization (corporation, partnershiq etcJ: ~ (lU t ~T~I ~'I1~ V %r%21 w\!.A ENT <br />2. OperaBon mame fait, mine or site name): ~LA SSE, N ~1~ l' <br />3. Permitted acreage (new or existing site): permitted acres <br /> 3.1 Change in acreage (+) acres <br /> 3.2 Total Acreage in Petmit Area acres <br />4. Fees: <br /> 4.1 New Application: 1 094.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(1[)): 719.00 application fee <br /> 4.2 Conversion Fee (from I l Od [0 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: )`1 ~'1Q~4Q. <br /> 5.1 Incidental commoditie(s) to be mined: 1 ~~L\ / lbslCons/vr 2. / Ibs/I'ons/vr 3. / Ibs/Cons/vr <br /> 4. / Ibs/I'ons/vr 5. / Ibs/Cons/vr <br /> 5.2 Anticipated end use of primary commoditie(s)tobemined: wOV ~ 1-1'A\tJTioNtAF~~.f'i <br /> Anticipated end use of incidental commoditie(s) to be mined: tJ~ A <br />