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m- moos-o3a <br />CONSTRUCTION MATERL4LS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />~~~;s_;~l~~"J <br />/ h1Al` 0 ~ 2C05 <br />°-i„~zic.^. N [°ir.:niz & GooioBY <br />Permit # M -_ _ _ (Please reference the file number currently assigned to this 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: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by <br />the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure <br />to include one (1) complete sieved and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of <br />Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 81/2" X 11" or 8 <br />1 /2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL informatioe described below. <br />1. Amoticant/ooerator or commanv name (name to be used on mermitl: Sprague Scraper Service, Inc. `~ <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />1.2 I.R.S. Tax ID No. or Social Security Number: Tax ID <br />2. Operation name (pit, mine or site Hamel: S_n_ragne Scraner Service Pit <br />3. Permitted acreaee (new or existine site): 9.9 permitted acres <br />3.1 Change in acreage (+) 0 acres <br />3.2 Total Acreage in Pezmil Area g 9-acres <br />4. Fees: <br />4.1 New Application: $ 1094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): 719.00 application fee <br />4.2 Conversion Fee (from 1104 to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primarv commoditie(s) to be mined: Rravel Sand Clay. <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/I'ons/vr 2. / ]bs/Tons/yr 3. / Ibs/I'ons/vr <br />4. / Ibs/fons/vr 5. / Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />Anticipated end use of incidental commoditie(s) to be mined: <br />