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~ III IIIIIIIIIIIII III <br />STATE OF COLORAUU <br />DIVISION Of MINERALS AND GEOLOGY <br />Department of Natural Rewu¢es ~~~~~~~ <br />7373 Sherman $t., Room 215 <br />Denver, Cobrado 80203 <br />Phone: (303) 8663567 <br />FAX: (3031832106 <br />. / ~oxsTlzQ~IOa ,m,,,,~TaT~ RECEIVED nEPnR~rrr~L <br />(/ LIMITED n~ACP OPERATION (llo) JUL D7 1991 SOURCES <br />RECLAMATION PERMIT APPLICATION FORM Roy Ranrr <br />Goernor <br />Qivision o) Minerals t~ Geaoyy ~,,,,~ s_ ~,,,~,~ <br />E.mrtie Dirtttor <br />MiduN B. Lori <br />Divisgn Dircau <br />CfiECR ONE: New Application (Rule 1.4) X Amendment Application (C.R.S. 34-32.5-110) <br />Conversion Application (Rule 1.11) . <br />Permit # M _77 _ 326 -_ (provide for Aaeadaents and Conversions of <br />existing permits) <br />The application for a Construction Materials Limited Impact Xining (110) Operation Reclamation <br />Permit contains three major parts: (1) the application form; (2) Exhibits A-J and Exhibit L, <br />Addendum 1, am sections of Exhibit 6.5 and Geotechaical Stability Exhibit, as required by the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, and 6.5; and (3) the application fee. Nhea you <br />submit your application, be sure to include one (1) complete sinned and notarized IVORY oRIGZRAL <br />and one (1) copy of the completed ivory application form, two (2) copies of Exhibits A-J and <br />Exhibit L, appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check <br />for the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring <br />binder; maps should be folded to 8 1/2" % 11" or 8 1/2" % 14" size. To expedite processing, <br />please provide the information in the format and order described in this form. <br />---- - -- G~paT- OPERATION INFORMATION- - - <br />Type or print cleazly, in the space provided, all information described below. <br />1. Aaolicant/operator or company name [name to be used on permit} <br />Adience, Inc. (dba) BMI France <br />1.1 Type of organization (corporation, partnership, etc,):Corporation <br />1.2 I.R.S. Tax ID No. or Social Security Number: <br />2_ operation name (pit, mine or site name): Siloam <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+ or -) <br />Total Acreage in Permit Area <br />4. Fees- <br />Pit <br />9.9 permitted acres <br />-0- acres <br />9.9 acres <br />4.1 New Application 875.00 application fee <br /> ( <br />. <br />3 <br />5 <br />5( <br />F <br />~ 575.0 fee <br />i <br />4.2 Fee <br />(from <br />110d <br />t <br />110 <br />875 00 conversion <br />le <br />onversioa <br />C ~( " <br />Dil <br /> Decorative Road <br />~ <br />5. Primar y commodities} to be mined; Clay Rrrk ~ytari <br />al gj.~FL Rhin .Rtnnc <br />5.1 Incidental commoditie(s) to be mined: 1. - lbs/Tons/vr <br /> 2. / lbs/Tons/Vr 3. / lbs/TOnslvr <br /> 4. / lbs/Tons/vr 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: C~~ =r^~~~inn atar;a7a <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />