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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY R^~E~V <br />Department of Natural Resources l~C V E~ <br />t373 Sherman St., Room Z75 <br />Denver, Colorado 80203 rr g 9 qnn / D I V I S I O N O F <br />Phone: (303) 866-3567 CC L J 2~2 / MINERAL S <br />FAX: (303) 832.8106 ~ Uieisl0o of & <br />Minerals and Geology G E O L O G Y <br />CONSTRUCTION MATERIALS R E c t. a M a r I o N <br />MINING•SAFETY <br />- REGULAR (112j OPERATION <br />RECLAhIATION PERMIT APPLICATION FORM / 8iR Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: X New Application (Rule 1.4.5) _ Amendment Applicaflon (Rule 1.1 t<naer s. Long <br />~ivision Director <br />_ Conversion Application (Rule 1.11) <br />Permit # M -~L-~/ (provide for Amendments and Conversions of existing permits) <br />The application for a Cons traction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) ilte application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnicat Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete siened and notarized IVORY ORIGINAL and four (4) copies of the completed Ivorv <br />application form, five (5} copies of Exhibits A-5, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the . <br />applicaton fee described under Section (4) below, Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8112" X 1 I" <br />or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this farm. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />Aaoticant/onerator or comoany name (name to be used on oermitl: Ild 1 1 - I rWl n CO rp0 rdt i On / <br />1.1 Type of organization (corporation, pazmership, etc.): Corporation <br />1.2 LR.S. Tax LD. No. or Social SectsityNtunber: $4-052-4573 <br />2. O~rerationname(uit.mineorsitenameZ: 5ernhdrdt Resource <br />3. Permitted acreaee (new or existine sitel: 2$C . I92 permitted acres <br /> 3.1 Change in acreage (+) acres <br /> 3.2 Total acreage in Permit azea 28G .1~ 2 acres <br />4. Fees: <br /> 4.1 New Application $2.344.00 application fee <br /> 4.2 New Quarry Application 52.906.00 quarry application <br /> 4.4 Amendment Fee 51.938.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) 52.344.00 conversion fee <br />5. ~rimarv commoditie(s) to be mined: Sdnd gravel <br /> 5.1 Tncidental commodite(s) to be mined: 1.901 d b lbs/Cons/vr 2. s0 i 1 / inn lbs/I'ons/yr <br /> 3. ! - lbsl'I'ans/vr 4. ~L lbaft'ons/vr 5. / lbs/I'ons/vr <br /> 5.2 Anflcipatedenduseofprimarycomnwditie(s)tobemined: COnstructtOn r7ateridlS <br /> 5.3 Anticipated end use of incidental commodities} to be mined: <br />