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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY R~C <br />Department of NaNral Resources ~/ 1 s~ <br />1313 5hennan St., Room 215 V O L O RA D O <br />Denver, Colorado 00203 FEB ~ DIVISION O F <br />Phone: (303) 866.3567 _ CONSTRUCTION 11~A7'F.RiAi C ~ 1~ M I N FORA L S <br />FAX: (303) 832~t 06 REGULAR (112) OPERATION Uttr~10a olMinerels d ~ e <br />GEOLOGY <br />91r RFCLANATION•NIN ING <br />RECLAMATIONPERM[TAPPLICATIONFORM oo~o SAEFTY•ECIENCE <br />M- 2~5 - Dhlo / B;aoweRs <br />CHECK ONE: Tltero V a Fik Number Already Assigaed to this Operation ewemor <br />Russell George <br />Permit # ~-^ _ __ (Please reference the file mmmber ciarenfly assigned to this operation) Executive Director <br />%New Applicafion (Rule 1.4.5) _ Amendment Application (Rule 1.10) Dirnlion Director <br />Conrersbn Application (Rule 1.11) Natural Resource trustee <br />Permit # ~_-_ __ ipravlde far Amenthnenb end Conversbns of existing petmits) <br />The application far a Construction Materials Regular 112 Operation Reclamation Permit contains throe majarperts: {1) the application form; <br />(2) ExhLbits A-S, Addtadum 1, any sx6ams ofExhibit 6.5 ((ieoteelmicel Stability Exhibit; and (3) the applicationfee. Whmyou submityan• <br />application, be sun to include o~ (1) complete sicned andnamri?.ed ORIGINAL and one (1) copy ofthe completed epplicatienfatm, two (2) <br />copies ofExblbits A-S, Addcodum t, appropriate sections of6.5 (Oeoteelmical Stability Exbi'6it, sod a check forthe epplicatiaDfee desm'bed <br />under Section (4) below. Exhtbits should ~~ be bound ar in a 3-ringbind~ maps shaildbe Folded to 81R' X 11"ar 81R" X 14" sine. To <br />expedite processing please psovide the infama2ion is the feamai and order descnlxd in this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the <br />ELI. hEformatlon requested 6ekrw. <br />/it~ioffat County $oard of County Commissioners <br />AnnlicanUonerator or eomnanv name (name to he aced on aerFtEitl: <br />1 1 .Pypeofarganization(caporetion,pmtnahip etc.): Local Government <br />1.2 LR.S.TmrLD.No.orSa«elSecwityNualba: <br />2. O~eratbn name foil. mtne or tote namel: <br />3. Permitted acreage (new or eldstLa~ dtel: <br />3.1 Change in acreage (+) <br />3.2 Total ecaeage in Permit area <br />4. FS~: <br />30.85 p~;uaa eEaes <br />30.85 acres <br />30.85 awe <br />4.1 New Application XXX $2.344.00 applicatioafee <br />4.2 New Quarry Application $2.906.00 gnmry applicatiaa <br />4.4 Amendment Fa $1.938.00 amendm®t fee <br />4.5 Ceavrtsian to 112 operation (set by staulte) 52344.00 cometsion foe <br />5. Primanoommodttk(sltobemined: Sand Gravel <br />5.1 IDCidsmal oommoditie(s) to Ire mined: 1. _N~A - Ibs/foFlshr 2. / Ibs/I'ons/vr <br />3. / ibs/I'onslvr 4. / Ibs/fans/vr 5. / Ibs/Tons/vr <br />5.2 AEtGcipatedeodtueofprimarycommoditie(s)tobemined Road Niaintenanee IVaterials <br />5.3 Aaricipated end use ~' incidental commoditie(s) W be mined: NSA <br />Office of Office of Colorado <br />Mined Land Reclamation Arrive and Inactive Mines Geological Survey <br />Powderwash Pit No. 66 / <br />