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~ -~.o0 7 -- 0 ~``~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources ` 'C <br />13135herman St., Room 215 RE~i~~UGD COLORADO <br />Denver, Colorado 80203 D I v l 5 l o N o f <br />Phone: (303) 866-3567 NOV 15 2007 MINERAL S <br />FAX: (303) a32-8106 G E O L O G Y <br />Division of Reclamation, RECLANATION•MINING <br />Mining and Safety SAFETY•SCiENGE <br />CONSTRUCTION MATERIALS <br />I.IIISITED IMPACT (110) OPERATION aill ovens <br />Governor <br />RECLAMATION PERMIT APPLICATION FORM Russeu George <br />ERecutive Director <br />Ronald W. Cottony <br />Division Director <br />CHECK ONE: There is s Fr7e Number Already Asaigrted to this Operation Natural Resource Trustee <br />Permit # M -_ _ _ (Please reference the file nlunber ctarently assigned to this operation) <br />~ New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Petmit # ~_-_ -_ (provide for Amendments and Conversions of existing permits) <br />The application foraConsttuctionMaterialsI.imitedhnpad(110)OperationReclemationPermitcantainsthreemajarparis: (1)tlteapplication <br />form; (2) Exhibits A-J, Exhibit L, Addendum 1, a~ sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and <br />outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When yot~sttbmit your application, be sure to include one <br />(1) comolete si>nred and notarized ORIGINAL and one (1) copy ofthe completed application form, two (2) copies of Exhibits A-J, Exhibit L, <br />Addendum 1, and appropriate sections of 6.5 (Geotectmical Stability Exhibit), as required, and a check for the application fee described under <br />(4) below. Exhibits should NOT be bourLd or in a 3-ring binder, maps should be folded to 8 1 /2" X 11" or 8 1 /2" X 14" size. To expedite <br />processing, please provide the information in the format and order described in this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, is the space provided, ALL Information descried below. <br />1. Anolicant/oaerator or comoanv name (name to be used on oermk): bs,l~se ~~ C g 1~ frT, <br />1.1 Type of organization (corporation, partnership, etc.): T,o c a t [; nva r n m a n t <br />1.2 I.R S. Tex ID No. m Social Security Number: <br />2. Ocerathon name tole. mhne or aka camel: r t a r lr p ; r <br />3. Permitted acreage (new or eiistin8 aka]: <br />3.1 Change in acreage (+) <br />3.2 Total Acreage in Permit Arcs <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.RS. 34-32.5-125(II)) <br />permitted acres <br />acres <br />acres <br />$1,258.00 <br />~1,~ 4~ application fee <br />~' i~:00- application fee <br />4.2 Conversion Fee (from 11 Od to 110 8$ 75.00 conversion fee (Rule 1.11.2(2)) <br />5. Prmsarv commodkie(a) to be mined: Land t, r a v a l <br />5.1 Incidental commoditie(s) to be mined: ]. ~ / ]bs/fons/vr 2. / lbs/Tons/vr 3. / ]bs/I'orrs/vr <br />4. / Ibs/Ton~ 5. / IbslTons~r <br />5.2 Anticipated endllseofprimarycommoditie(s)tobemined: County Road Maintenance <br />Anticipated end use of incidental commoditie(s) to be mined: u/ a <br />Office of Office of Colorado <br />Mined Land Reclamation Active and InaRive Mines Geological Survey <br />