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Ap?lication ?orm _`or a ?ermit <br />to <br />Conduct Ccal ~' ado <br />Stace of Colorado ,;p olicat:on to conduct surrace <br />. ~~~~ . <br />De car _~ent o° ~'a tsra; 3esources ~ ~~~ or underground cca_' .ain_ng <br />Y..:..D ~uVD ~SC~,'".i.?ZON DILZSION pEC 3 activities or ct her surface coal <br />13ZJ sher~an Street, =xm C23 mir.iag a.:d reclasa tion oceracions <br />Csver, Colorado 80203 (303)3J9-3567 A~~~Iorado pursuant to CRS 1973, <br />~~~~~~ i.nNif 't~t'vLAM <br />t;uw.0apt. ~ y~tura! A~p~rcesJ-1D1, ec. seo. <br />~~ <br /> <br />'or an a?alicatien to be deemed complete by the Division _-ursuant to Cs 1973, <br />34-3J-103 (s) end Rule 1.04 (30), an applicant must: (3) su??lv all `-:or-at`on as <br />scec_'fied on ttzis application _`or:n; (<') submit five re?reducible copies of t e ?ermit <br />ac?lication with original signatures; and (3) ?ay ~e ac?repriate fee rewired by <br />.die 2.01.6. <br />2l ea se note tl-.at this form is only a Listing of ceneraI catecory re?virements and <br />=oes not constitute a chec.l-list of detail e3 oe_*~mit a?olication recuir=_~ents. A <br />:i=.ding of c~mpleteress should not be i~ter2reted to ?amply ade?vacy of an aDO1i- <br />c_t_'on. Addticnal information not Listed on this fen ray be reavired _°or 3_'eavacy <br />depending vpcn the individual ciscu.-stances of an agol_'cation. <br />This form consists of t:oo mayor arts: (l) a section entitled General Ocerat_'on <br />r.:fOZT2tiOn end (2) a section entitled Aoolica tion Recuirements. Scec_°ic instruc- <br />~iors for .filing in the necessary info^ation _°or each section appears ircned'ateiy <br />be1c:+ the ~_t_'e of each section. <br />Jc:7r~y pnr?~TSON w~ORINII T_T17f7 <br />Ty?e cr :r_nt clearly the aporccriate inrcrmaticn as Zisted below. Sugplame_atal <br />s.`.eets .:ay be used as -ecessa.ry, such sheets .:just be attached to the form and re- <br />_'er^nced or %eved to the numiers on the fora. <br />1. :Tame of Oceration <br /> (?it, mine or site name) COaI GU}Ch Mlne <br />2. :7eme of Applicant <br /> (::a.-e to oe ssed on per~,it - Peerless Resources, Inc. <br /> the ? e_~m.ittee) <br />1a. Address and phone nurwer of <br /> local offices (None established at this time) <br /> 5528 Indian Rock Road <br />23. Address and phone number of Salt Lake City, Utah 84117 <br /> General offices. (801) 272-2365 <br />3. :fa.~e and pi:one nuabe= of ?erson I L. Dale Larsen <br /> staff meabers should contact (801) 272-2365 <br />?. ?arent Corxraticn, if any <br /> (*nclude name snd address) None <br />I <br />