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TATE OF COLORADO <br />DIVISION Of MINERALS AND GEO(.OGY <br />Department of Natural Resources • <br />7313 Sherman Sc, Roam 2t5 <br />Denver, Colorado 80203 <br />Phone: i303}866-3567 <br />FAX: (303)832-8106 <br />RECEIVED <br />FEB 1 0 2004 <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING•SA FETY <br />Division ~f Minerals and Geology <br />CONSTRUCTION MATERL4L5 <br />REGLZAR (112) OPERATION <br />RECLAbIATION PERbIIT APPLICATION FORM Bill ovens <br />Governor <br />Greg E. Walther <br />Executive Director <br />E~CK ONE: %New Application (Rule 1.4.5) _ Amendment Applicaion (Rule 1.1 i<hael B. Long <br />Division Director <br />Conversion Application (Rule 1.11) <br />Permit # M -aL1p4_~-_ (provide for Amendments and Conversions of existing permits) <br />re application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />Iplication, be sure to include one (1) complete sinned and notazized IVORY ORIGINAL and four (4) copies of the completed Ivorv <br />rolication form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the . <br />;plicadon fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded [0 8 lr" X 11" <br />8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />ADplicanVoperator or companvname (name to be used on Dermit}: Asphalt Specialties Co. , Inc <br />1.1 Type of organization (corporation, pazmership, etc.): <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />Operation name pit, mine or site name}; Tnrn pjka Mining Racnurra <br />Permitted acreaee (new or existine site}: 9 7 5 G permitted acres <br />3.1 Change in acreage (+) <br />3.2 Total aaeage in Permit azea <br />Fees <br />acres <br />acres <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarry Application $2 906.00 quarry application <br />4.4 Amendment Fee $1.938.00 amendmen[fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />Primary commoditiels) to be mined: Sand Gravel <br />5.1 Incidental commoditie(s) to be mined: 1. - lbs/I'ons/vr 2. / lbs/I'ons/vr <br /> 3. / IbslI'ons/vr 4. / lbs.ri'ons/vr 5 . / lbs/1'ons/kr <br />5.2 Anticipated end use ofprimazycornmodi[ie(s)tobemined; Construction Corter~'e~/i5plw l't <br />5.3 Anticipated end use of incidental commoditie(s) [o be mined: None <br />