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STATE OF COLORADO <br />DlVI510N Of RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />7313 Sherman SL, Room 275 <br />Denver, Colorado 80203 \ C O L O R A D O <br />Phone: 1303) 866-3567 ~I ~5N J,n , C~ D 1 v 1 9 I O N o r <br />I' RECLAMATION <br />P83z-a7o6 ~~ ~ MI &NG <br />R ~ ~~ ~0 ~ CONSTRUCTION MATERIALS SAFETY <br />1 ~~0, LIMITED IMPACT (110) OPERATION 8i11 o1NefS <br />~G 3 m~ cov~~m.9. <br />P n~\9~d~ ,J,\p0~ RECLAMATION PERMIT APPLICATION FORbf E c~cutie Dirccmr <br />Dina . ^a5ar16~ Ronald w. cannot <br />~.~ ~~ ONF.: There is a File Number Already Assigned to this Operation Dm~sion Director <br />ka[ura~ Rewurce TruNee <br />Pemilt # Lt -_ _ _ (Please reference the fde number currently assigned re this operation) <br />t~New Application (Rule 1.4.5) Ameudmeut Application (Rule 1.10) <br />Conversion Application (Rule Ll l) <br />Permit # M -,-J= _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materia]s Limited Impact (f 10) Operation Reclamation Permit contains three major parts: (l) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as requited <br />by the ORice, and outlined in R7aSes 6.1, 6.2, 63, 6.5, and 1.6.2(I)(b); and (3}the application fee. When you submityour application, be <br />sure to include one (1) corttnlete signed and nokarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required and a check for <br />the application fee describedtutdet (4) below. Extu"bits should NOT be bound or in a 3-ring binder; maps should he folded to 8 112" X <br />11" or 8 1!2" X 14" size. To expedite pmcessing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATI023 <br />or print clearly, in the space provided, ALL information described below. <br />1. AnulicaaUoperator or comnaoy name (name to be used on cermitl: A~~+/i}.li ~ P / ~~ P.r7{- L L <br />1.1 Type of organization (corporation, partnership, entc.): n <br />2. Omerattoa nameluit. mine or site namel: A/2l"n~~ l'n/G Uf (L ~i 7~' <br />3. Permitted acreage (new or existing aitet: ~ 2 permitted acres <br />3.1 Change in acreage (t) N~" acres <br />3.2 Total Acreage in Permit Area ~ at `f acres <br />4. Fees: <br />4.1 New Application: 41,_094.00 application fee <br />Amendtnent Pee (C.R.S. 34-32.5-125(11)): 7~ 19.U0 application fee <br />4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(sl to be mined: ,~~J SO / L^. ~.,_-. <br />5. ] Incidental commoditie(s) to be mined: t./~DAO iYvTons/vr <br />4.7"`s d I~Tons/fir <br />5.2 Anticipated end use of primary corttmoditie(s) to be mined: <br />2. ~r~ -titef['ons/kr 3• ~ X70 ~1~'I'onsivr <br />5. ~i Op0 1~PI'onslvr <br />~~~/ --- <br />Anticipated end use of incidental commoditie(s) to be mined: __,_/1/f/~_. <br />r~ v~ ~. Ct-- ~ <br />Offim of <br />Mined W nd Reclamation I _I ,., ~ ~ ~1 Y l 1 ~ ,~ <br />+li' `! 11 n ..~I .rs~ ' , D ~s+fc e~C,~ «se~ <br />aJ <br />