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4/01/02 MON 18:98 FA% 8702411b18 MSnernls & Geolosy G Jcc <br />STATE OF COLORADO <br />DIVISION OF lvtINEKAtS ANO GEOLOGY / <br />D,.I+.inmanl of Nat4ral Rasewrees ,r c Yl~r <br />~ILG <br />~ <br />F~ ®f <br />~ <br />Ll I.1 Sharman SL, Room Ili yAp a~ p IyMij / <br />1•If11~ L O GIIYL tl <br />,~ <br />a <br />~~ ~+~,~, y.I®~~ O I v 15 I o N O F <br />[:rmer, Culamdu BOLO) G/ M I N E liA C$ <br />fhune:1.7011flhG-S.Shl ; <br />V <br />& <br />`r.\x'. I~~I11'41 Bl~-73106 ~~~{-~ t <br />Blta~ y- E O L O G Y <br /> p(gi*a•,.. ~t Potlwamle ~ QaoPs®y <br />~~~: II~ e~~ <br />~1/ A5CLA TIA-ION <br />r <br />I <br />NG• <br />GF- <br /> CONSTRUCTiON~tATERIALS e, <br />M <br />NI <br />S <br /> T <br />OiV ' <br /> I <br />R£GULa1R (112) OPER.; <br /> RECLAMATION PERMIT APPLICATION FORM eau O.v?ns <br />Cu~amo. <br /> Gree E. Walther <br /> Exect,liva nirecwr <br />Amendment A [ieation Rule I.10'"ithael B. tons <br />CHECK ONE: ~ New Application (Rule 1.4,5) .~ PP ( ~Mx3on oimcwr <br />Conversion Application (Rule 1.11) <br />permit # _iv~-~.-~-~ (provide For Amendments and Coaversioas of existing permits) <br />The applicttion for a Conswedon Mazerials Regular 112 Operidon Reclamadon Permit contains three major pare: (1) the appliption form; <br />(2) Exhibits A-S, Addentitmt 1, arty sections ofExhibk 6S (deotechnical Stability Ettbibit; end (3) the application Eee. When you submit your <br />appGcarioq be sate to include ant (1) sm to eta sgned and notarized NOttY ORIGifNAL and font (4) copies of the completed ivory <br />application Eorm, fivo (S) copies ofExhbits A-S. Addendum 1, appropriate secboas oE6,5 (Geotechnical Stability Exhibit, and a cheek for <br />the application fee described under Section (4) below. Exhibits should PLOT be bound or Ina 3-ring binder, maps should be folded to <br />8 1/2" X 11" or 8 1/2" X 14" siu. To expedite Processing, please provide die informariw in the format and rnder described in this fotm- <br />GENERAL OPERATION iNFORM.4T[ON <br />Type or print clearly, in the apace provided, ALL information requested below. <br />I. Applicant/operator or campanv name (name to be used on oermitl: <br />1.1 Type of organimtion (corpotarioq pstmership, etc.): ~.1~x3 r-E /y otJETzn1MErJT <br />1.2 IRS_ Tax LD. No. or Social Security Number. ~`~ -Co O ~o7S°l <br />2. Ooention none roit_ mine oral a name]: ~~ _ <br />3. Ye~ttitted screaeelnew or ezistine site]: <br />3.1 Change in acreage (+} <br />3.2 Total aaeage in permit area <br />4. Fees: <br />4.1 New Application <br />4.? New Quarry Applicazion <br />4.3 Milling Application (Non•DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />2 ~• 7 permitted acres <br />acres <br />'y7. 7 acres <br />a,3yyoo ~-- <br />application fea <br />00 quarry application <br />53.Ig0.00 millingapplicaticn <br />51550.00 amertdmentfee <br />SI.875.00 conversion fez <br />S. Primary commotlitiets] to b miq~d: sSAN ~ ~ G ~/~y~L <br />5.I lncidentnl oommoditio(a) to be mined; 1. Ibs/Tons/vr 2. / Ibs/Cons/yr <br />3. / ibs(fons/y,I 4. / Ibs/Tons/vr 5. _ / Ibs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined:. /~0~41~, ~a.4S E _ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined; <br />