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.4.18 Exhibit R- Proof of Filing with County Clerk and Recorder <br />ST1~TE <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />Sherman St., Room 21 i <br />r, Colorado 80203 <br />Pone: !303)866-3567 <br />F.4X: (303) 832-8106 <br />,. <br /> <br />CONSTRUCTION hIATERL~LS <br />REGULAR (112) OPERATION <br />I~ADO <br />r- -~ - „_ ~--~ <br />RECEN <br />D I VISION O F <br />MINERALS <br />GEOLOGY <br />ftECIAMATION <br />MIN ING•SAFETY <br />RECLAMATION PERrVIIT APPLICATION FORM Bill Owens <br />JUN 2 5 2004 <br />Division of Minerals and Geeovernor <br />CPagI~E. Watcher <br />Ezecuti.e Director <br />:CK ONE: R New Application (Rule 1.4.5) _ Amendment Application (Rule 1.1Q~ichael a. Long <br />uiv~s~on Director <br />_ Conversion Application (Rule 1.11) <br />Permit # M -~ -_ (provide far Amendments and Conversions of existing permits) <br />application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />?xhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical StahilityExttibit; and (3) the application fee. V/hen you submit your <br />ication, be sure to include one (1) complete siened and notarized IVORY ORIGINAL and fora (4) copies of the completed Iverv <br />ication form, five (5) copies of Hxhihits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnicat StabilityEzhibit, and a check far the <br />icadon fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 1 i" <br />lll" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GE,~fERAL OPERATION IIv-FORMA'T'ION <br />Type or print cleazly, in the space provided, ALL information requested below. <br />i~licant/operator or company name (name to be used on permit): FARFRUMWURKIN. LLLP <br />1.1 Type of organization (corporafion, paztnership, etc.): LLLP <br />1.2 I.RS. Tax I.D. No. or Social Security Number; <br />Operation name (pit, mine or site Hamel: FILE PIT 112 <br />Permitted acreage tnew or existine site): permitted acres <br />3.1 Change in acreage (+) <br />3.2 Toter! acreage in Permit azea <br />Fees <br />acres <br />acres <br />4.1 New Application 32.344.00 application fee <br />4.2 New Quarry Application 32.906.00 quarry application <br />4.4 Amendment Fee 31.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 32.344.00 conversion fee <br />Primary commoditie(sl to be mined: SAND GRAVEL ROCK <br />5.1 Incidental commoditie(s) to be mined: 1. - lbsil'onstvr <br />3. / ibs(fons/vr 4. f lbslI'ons/vr <br />2. ! lbs/i'otts/vr <br />5. / SbsII'onslyt <br />5.2 Anticipated end use ofprimazycotnmoditie(s)tobemined: CONSTRUCTION MATERIALS <br />Anticipated end use of incidental commoditie(s) to be mined: <br />File Pit 112 DMG Permit Application <br />Page 26 of 27 <br />