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TATE OF COLORADO <br />DIVISION Of MINERALS AND GEOLOGY f/ <br />Department of Natural Resources ~ = v ~ - ~J E <br />7313 Sherman St., Room 275 kUu i 9 2003 ~ <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 Division sf Minerals and GeoloyY <br />FILE C 0 PY CONSTRIICTION MATERIALS <br />f®fl SCANN/N>ATIONPR(ERMTl'OAPPLICATIONFORM <br />CHECK ONE: There ffi a FY7e Number Already Assigned to this Operation <br />Permit # M X03- 6~7U-'~ (Please reference the fl7e number currently assigned to this operatics) <br />~_ New Application (Role 1.4.5) _ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Pe®it # M -_ -_ (provide for Amendments sad Conversions of existing permits) <br />100 <br />The application far a Construction Materials Regular 112 Operation Reclamaticm Pennif contanas three majorparts: (1) the application form; <br />(2) Exhibits A-S, Addesdmm 1, mmy sections ~Exhibi[ 65 (t3eotechnical Stability Exhibit and (3) the application fee. When yon sabtnit your <br />application, be s[me to include one (1) co»lete si>med mmd notarized IVORY ORIGINAL and oIre (1) copy ofthe completed Ivor application <br />form, two (2) copies ofExhrbits A-S, Addend>ffi 1, appropriate sections of 6.5 (Geotechlrical Stability Exhtbit, and a check for the application <br />fee d snider Section (4) below. Exhrbils should NOT be bo®d ~ m a 3-ritlg binder, maps should be folded to 8 12" X 11" or 8 1/2" <br />X 14" size. To expedite processing, please provide the info>mation in the format and order descnbed in this foam. <br />GENERAL, OPERATION INFORMATION <br />Type or print clearly, m the apace provided, ALL information requested below. <br />1. AnDlicantloaentororcomoanvname(nametobenaedoncermit): Baca County <br />1.1 Type of organization (corporation, partnership, etc.): <br />1.2 LRS. Tax I.D. No. or Social Sectaity Number: <br />2. Operation name (nit. mine or sRe name): <br />3. Permitted acreage (new or eesthra site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />Hinds Pit II 35 <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: r_,-~.,o i ~,~ _ <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/1'ons/y[ <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cattany <br />Acting Division Director <br />permitted acres <br />saes <br />acres <br />$2.344.00 application fee <br />$2.406.(K1 gantry application <br />$1938.00 amendmealfee <br />x2.344.00 conversion fee <br />2. 1 IbsJTons!vr <br />3. / lbs/Tanslyr 4. 1 lbs/Tons~r 5. / 1bslTons/vr <br />5.2 Anticipated end use of primary commodi[ie(s)tobemined: When supply ig depleted. <br />5.3 Anticipated end use of incidemal commoditie(s) to be mined: <br />