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JUN_9 ~ ~ <br />ptyleloo of Mia?raiasnd Geology <br />~~ ~DO to -D ~j ~~ <br />CONSTRUCTION MATERIALS t/ <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />ens <br /> <br />Penn/np M -_-_ _ (Please reference the file number curtently assigned to [his operation) <br />V New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (1 IO) Operation Reclamation Permit contains three major parts: (1) [he <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections ofExhibi[ 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) [he application fee. When you submit your application, be <br />sure [o include one (i) comolete sieved and notarized ORIGINAL and one (() copy of the completed application form, two (2) copies <br />of Exhibits A- I, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geo[echnical Stability Exhibit), as required, and a check for <br />the application tee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded [0 8 I/2" X <br />11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the forma[ and order described in [his form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below, <br />1. Annlicant/onerator or company name tname to be used on permit): Yjt'1 ~F~11-~~i (~ l-D\l.lJh ~~ <br />1.1 "type of organization (corporation, partnership, e[cJ: l~ f)la V~ \~-S ~~t~tJt~~ ( <br />2. Operation name fpit, mine or site name): <br />3. Permitted acreage (new or existing sitel: <br />3. i Change in acreage (+) <br />3.2 Total Acreage in Permit Area <br />U - H permitted acres <br />acres <br />acres <br />4. Fees: <br />4.1 New Application: 1 094.00 plica[ion fee <br />:lmcndment Fee (C.R.S. 34-32.5-125(II)): 19.00 application fee <br />43 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />5. Prim:vv commoditie(s) to be mined: ~ f`S1 <br />5.1 Incidental commoditie(s) to be mined: lt~l1 ~/ lbs/I'ons/vr 2. / Ibs/Fons/vr 3. / Ibsll'ons/vr <br />4. / Ibs/Tons/vr 5. / lbs/Cons/vr A ~~ <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~'~lr 1 U,'lkll~~~iti ~ W <br />Anticipated end use of incidental commoditie(s) to be mined: <br />