_PERMIT FILE - M1999074

• Permit No: M1999074
• IBM Index Class Name: Permit File
• Doc Name: HARD ROCK METAL MINES LIMITED IMPACT OPERATION 110 RECLAMATION PERMIT APPLICATION FORM
• Media Type: D
• Archive: No

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�-A-rr OF COLOMDO
DIVISION OF MINERALS AND GEOLOGY JIII IT1111III J
Department of Natural Resources 999
1313 Sherman$t., Room 275 Denver,
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Denver,Colorado 80203
Phone:[phone] �`\Ja0
FAX,[phone] ��G
DEPARTMENT OF
1�c9 NATURAL '
HARD ROCK/METAL MINES O "".,.:RESOURCES
LIMITED IMPACT OPERATION 110 (2) ) )V)S10n 01 M%nef Roy
o Romer
RECLAMATION PERMIT APPLICATION FORM
James S Lochhead
Executive Director
Michael B.Long
Division Director
CHECK ONE: X New Application
� (Rule 1.4) Conversion Application (Rule 1.11)
Permit # M- C
� 1 -v1- (provide for Conversions of existing permits)
The application for a Limited Impact (110(2) ) Mining Operation Reclamation Permit contains three
major parts: (1) the application form; (2) Exhibits A-J, Addendum 1, any sections of Exhibit S
and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules 6.1, 6.2,
6 .3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure to
include one (1) sinned and notarized Grey Original and one (1) copy of the application form, two
(2) copies of Exhibits A-J, appropriate sections of 6.4.19 (Exhibit S) , and 6.5 (Geotechnical
Stability Exhibit) , as required, and a check for the application fee described under (4) below.
Exhibits should NOT be bound or in 3-ring binders; maps should be folded to 8 1/2" X 111, or
8 1/2" X 14" size. To expedite processing, please provide the information in the format and order
des this form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, all information described below.
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1. Applicant/operator or company name (name to be used on permit)
Precious Offerings Mineral Exchange, Inc.
1.1 Type of organization (corporation, partnership, etc. ) : Colorado corporation
1.2 I.R.S. Tax ID No, or Social Security Number: 84-1477932
2. Operation name (pit, mine or site name) : Brown Derby Mine
3 . Permitted acreage: 0.5 acres, more or less permitted acres
4. Fees:
4.1 New Application $875.00 application fee
4.2 Conversion Fee (from 110d to 110(2) , Rule 1.11.2 (2) ) $875.00 application fee
S. Primary commodities to be mined.: tourmaline specimens; lepidolite
6. Name of owner of the subsurface rights of affected land: Applicant, subject to U.S. rights
7. Name of owner of the surface of affected land: U.S. Bureau of Land Management
a. Names of the holders of any recorded easements on the affected land:
There are no recorded easements over the affected lands
8. Type of mining operation: — Surface X Underground — In-situ