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• ��� ������������� ��� • f mmi�4/ '-fy3 ;Jwao <br /> p <br /> 999 / 6nniPr' S766 4 /,87,5,00 <br /> STATE OF4COLOMDO <br /> DIVISION OF MINERALS AND GEOLOGY <br /> Dcpa e ofrlm nl of Nalu ral Rcsuurcc5 <br /> 3I4Sherman St, <br /> 5F,7Roo 21S <br /> Dcnve,.Colorado 80201 <br /> I'hunc.U0J1 86 <br /> 6 15fi7 <br /> FAX I1I111812-8I06 <br /> RECEIVU <br /> TRAL <br /> CONSTRUCTION MATERIALS AUG 1 6 SOURCES <br /> REGULAR OPERATION (112) <br /> RECLAMATION PERMIT APPLICATION FORM Roy Romer <br /> Division of Miners shidrfp2Bo9 <br /> cead <br /> Etecutive Dlrenn, <br /> Mu heel B.Long <br /> Division Duecwr <br /> CHECK ONE: " New Application (Rule 1.4.5) Amendment Application (Rule 1. 10) <br /> Conversion Application (Rule 1. 11) <br /> Permit f - goo► - ID9 (provide for Amendments and Conversions of <br /> existing permits) <br /> The application for a Regular 112 Operation Reclamation Permit contains three major parts: (1) <br /> the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical <br /> Stability Exhibit; and (3) the application fee. When you submit your application, be sure to <br /> include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed <br /> ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 <br /> (Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) <br /> below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br /> or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and <br /> order described in this form. <br /> GENERAL OPERATION INFORMATION <br /> Type or print clearly in the space provided the information requested below. <br /> --------------------------------------------------------------------------------------------- <br /> --------------------------------------------------------------------------------------------- <br /> 1. Applicant/operator or company name (name to be used on permit) : <br /> 1.1 Type of organization (corporation, partnership, etc. ) : _Uo(ic/WM.-Al 46,-ACY <br /> O! <br /> 1.2 I.R.S. Tax I.D. No. or Social Security Number: -6- 000- n1 6u <br /> 2. Operation name (pit, mine or site name) : lA/D/AA/ Sy/U.VGS f AR/C P/T <br /> 3. Permitted acreage (new or existing site) 'Zo permitted acres <br /> 3.1 Change in acreage (+ or -) acres <br /> 3.2 Total acreage in Permit area 20 acres <br /> 4. Fees: <br /> 4.1 New Application 10"51,875.00 application fee <br /> 4.2 New Quarry Application $2,325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) $3,100.00 milling application <br /> 4.4 Amendment Fee $1,550.00 amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) S1,875.00 conversion fee <br /> 5. Primary commoditie(s) to be mined: 67tg11E-Z <br /> 5.1 Incidental commoditie(s) to be mined: 1. _ - lbs/Tons/Yr <br /> 2. / lbs/Tons/yr 3. / lbs/Tons/yr <br /> 4. / lbs/Tons/yr 5. i lbs/Tons/yr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: Ram GA4yEL <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />