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~ III IIIIIIIIIIIII III REGULAR (112) PERMIT APPLICATION FORM RECEI~E® ARR ~ a 19SY J MINED LAcnnvu r~ This for contains two major parts: (1) General Operatior~~i~~~~~~riA~l~~2)~ E:2hibita A-P. When you submit your application, be 'sure 'Eo include four siEned copies of the General Operation Information, four copies of Exhibits A-P and a check for the application fee described under (4) below. To expedite processing, please provide the information in the format and order described in this form. ~ _ ~ ~ 7' ~ ~ ~ ~tce,v'~8997 X960-° GENERAL OPERATION INFORMATION Type or Print clearly, in the apace provided, all information described below. I 1. Applicant/Operator Name: Dotsero Block. Inc. 2. Operation Name (Pit, mine or site name): Dotsero Ouarrv 3. Application Type: Regular (112) Permit Operation. 1 4. Application Fee for Permitted Acreage* 65.52 permitted acres I ($50.00+ $15.00/acre, 1st 50 acres; $100.00/acre, 2nd 50 acres; $5.00/acre, 3rd 50 acres; $1.00/acre, any additional acreage; maximum fee of Note Permit acreage and application fee and attach check for this amount when you file. Sgb0.00 application fee. ~ 5. Substance(s) to be mined (e.g., gold/silver/gravel): Volcanic Cinder 6. Owner(s) of Substance to be Mined (check applicable box(s)): m Private ^ State ^ Federal ^ Indian 7. Owner(s) of Record of Affected Land (check applicable box(s)): ^ Private ^ State (SI Federal ^ Indian 8. Type of Mining Operation (check applicable box(e)): ® Surface ^ Underground ^ In-situ 9. Location Information. The center of the area where the majority of the mining will occur lies in: COUNTY: PRINCIPAL MERIDIAN (check one) ®6th (Colorado) ^ lOt6 (New Mexico) Ute TOWNSHIP (write number and check direction): T ~ ^ NORTR m SOUTH RANGE (write number and check direction): R ~_ ^ EAST ® WEST SECTION (write number): S ~~ QUARTER SECTION (check one): ^ NE ® NW ^ SE [~ SW QUARTER/QUARTER SECTION (check one): [] NE ^ NW [~ SE ® SW GENERAL DESCRIPTION: (miles and direction 2 00 Hiles Northeast of Dotsero follow north front- from nearest town and approximate elevation gem*nad r^ ~;rr road t adiny~o mine. * If the operator ie a unit of the State or county government, an application fee ie not required. A fraction of an acre must be counted ae one acre for fee calculation.