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~~ III IIIIIIIIIIIIIIII ~ (1~ <br />wrPUC+noty FORM <br />CHECK ONE: _ Naw Application (Rule 1.4) _Convamon Application (Rule 1.11) <br />Permit # M fPrm'~ for oonversiqu of exiefing pemrits) <br />The application far a Limited Impact Deaigruted Mittiig Operation Reclamation Permit contairm three major parts: (1) the <br />application form: (2) Exhibits A-]. any regtmed section of Exhibit S and Geotechrtical Stabr7ily Exln~bit, as tequied by the <br />Oflice, end ouftined m Rnlex R 1 F 7 F 4 10 en~l fi 4 and !il the a..rrmrliratirm fir_., WhL!! ypu t!ubmit yotu application, be sun <br />._ :.,,.,..,,.._,, n ~ .; of the loan, two (2) copies of Exhrbufa' A-J, <br />,~ ,,.,,.•..•-- ~.~ ~.~ matted and notarized ocigi~al and one (1) Dopy application <br />appropriate sections of 6.4.19 Exhibit S and 6.5 (Cxotedtnial StabrlAy Exhrbd), m rcgrmed, and a ~eeY far the appliation <br />fee described under (4) below. Exhrbifa should not be botutd or in a }ring binder, maps should be folded to 8 ln^ x 11^ « 8 <br />l!2" x 14^ size. To expedite processing Please provide the information it die format mid order deacnbedm this form. <br />GENERAL OPERATION IIVFORMATION <br />Type aU print clearly, in the apace Provided, aIl infoanation deacnbed below. <br />L Appficent/opetator or company name (mm~e W be used on pemtit): <br />(.'OM loe. <br />1.1 Type of otgmtiation (corporetion, per4tetattip, etc.): C~~ <br />1.2 IRS Tax ID No. or Social Security Number: <br />2. Operation name (pit. mine, or site name): rr+~ lIM M® <br />3. Pemutted acreage (new ar existing site): 6.47 pesmiGed aaa <br />3.1 Change in eaeage (+ or -): 2.47 saes <br />4. Fees: <br />4.1 New Application 5875.00 appticatiat fee <br />!.2 Conversion Fee (from I lOdto 110) (873.00 aonvasian fee (Ruk 1.11.2(2)) <br />S. Primary commodity (rrs) to be mired: Cali 89va <br />6. Name of owns to the subsnrfeoe rights of affieeted Isnd COM. Le. <br />7. Name of owner to the surface of affected lend: COM. Le. <br />8. Type of mining operation: X Surface _ Uttdagtotmd -Tn-sArr (Mlltln`) <br />9. l.ocatiorr atfo>mation. The g t~ of the arsa whore the majority of miring wrll seas ties ire <br />COUNTY Baaldatr <br />PRINCIPAL MERIDIAN (deck one): X 6th (Colorado) _ loth (New Mexico) _ Ute <br />SECTION (write number): S ~_ <br />TOWNSHIP (write number and deck direc4ion): T_~ X Nasth _ South <br />RANGE (write camber and check direction): R 72 _ East ~C West <br />QUARTER SECTION' (cheek one): _ NE ~ NW _ SE _ SW <br />QUARTER/QUARTER SECTION (check one): _ NE _ NW ~ SE SW <br />IiENERAL DESCRIPTION: (miles std dimction from rteareat town mid approxmrate elevation); <br />5.2l0 fad abvaLsn 10 mlNs wed ail Bodiar. CO. Ebvatkn 5350 to 8600 feat <br />1 <br />