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STATE <br />DlYLS10N OF MINERALS AND GEOLOGY <br />~pamment of Natural Resources <br />7313 Sherman St„ Roan 27s <br />Denver, Colorado 80203 <br />Phone: D03) 6663567 <br />FAX: (303) 832.8106 <br />CON5TRIICTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />COLORADO <br />COLORADO <br />DIVISION OF <br />MIN1<RALS <br />IGEOLOGYI <br />aF CLANATION•NINING <br />eArernsueeee <br />Bill Owenf <br />Goventor <br />CHECK ONE: Then la a File Number Already Assigned to this Operation <br />Permit # M -_-_ _ (Please reference the Ste numbs ctn'rently assigned to this operation) <br />New Application (Rule 1.4.5) _.___ Amendment Application (Rule 1.10) <br />`Conversion Application (Rule 1.11) <br />Permit # _ vj_f -`- _ (provide far Amendmmt* end Couvenlom of etds6ng permits) <br />Russell GeoBe <br />ExeMive Director <br />Ronald W, fathny <br />Drvtiron D4relmt <br />Natural Resource Trustee <br />The application for a Conshtrction Materiels Regular 712 Operation Reclaatation Permit contains t}uee major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, a>ry sedions ofExllibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. Whey you subiniiyota <br />eppficatioD, lie sure to i~luda one (1) Mete sitmcd and notarized ORIGINAL and one (I) copyof the completed applic~on form, two (2) <br />topics of Exhibits A-S, Addendum 1, appropriate sections of6.5 (Geotlxhnical Stab77ity Exhibit, end a chxk for the application fce described <br />I7ndaSection(4)below. Exln'bitsshouldIVO~ltebouudoriae3-ringbirxl~;mapsslunildbefoldedto812"X11'or81I1"X14"sze. To <br />expet~ite processing, please provide the infomlation in the format and order described in ibis form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, fa the apace provided, ALI, information requested below. <br />1. AoplicanUolxrator or rnmuanvname (Dame to be aced on a ~: <br />1.1 Type of organization (corporafioq partnership, etc.): <br />2. Operation name (nit. mime or site camel: <br />3. Permhted acrea¢e (new or etdstin¢ site): <br />3.1 Chmrge in aeneage (+) <br />3.2 Total acreage in Peitmt area <br />4. has: <br />4.1 New Application <br />4.2 Ncw t277arty Application <br />4.4 Amendment Fce <br />4.5 Conversion to 112 operation (set by starute) <br />5. Prinaarv oorpmoditie(sl to be mloed: <br />5.1 Incidental commoditie(s) to be mined: 1. - 1bsR'onslvr <br />3. / lbs/Tons/vr 4. / lbs/foltshr <br />i <br />5.2 Anticipated end use afprtmary commoditie(s) to be mined: _ <br />5.3 Anticipated end rise of incidental commoditie(s) to ix mined <br />permitted acres <br />X2.344.00 application fee <br />52.906 00 gttatry application <br />X1.938.00 emeodm~tfoe <br />E2.344.00 conversion fce <br />2. / lbs(lons(vr <br />5. / Ibs/fons/vr <br />otrre of orate er Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />