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~l - ~- 007- 0 3 <br /> STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department oI Natural Resources <br />7 <br />R <br />2 ^ ~ ^ ~' ,, ,.~ D <br />K ( _ <br />oom <br />75 <br />313 Sherman St, C O L O R A D O <br />Denver, Colorado 80203 <br />Phone: (303186b-356i JUN ~ 1L007 REC tLAMATIQN <br />FAX; (303) 8328706 MIN 1 N G <br /> n ~t .~~~~amation, <br />i <br />is <br />o <br />Div <br />E <br /> TY <br />SAF <br />t <br />l <br />~ <br />~ <br />CONSTRUCTION MATERIALS mg and Safety <br /> LIM[1'ED IbIPACT (110) OPERATION Hi0 °"`"" <br /> Governor <br /> RECLAMATION PERMIT APPLICATION FORM Russt l Georxe <br /> &ecuCrve Oirecrar <br /> Ronald W. Cottony <br />CHF,CK ONE: There is a File Number Already Assigned to this Operation oivisfon ofrMOr <br /> Natural Resource Trustee <br />Pem»t # M -_ ~ {Please reference the fife number currently assigned to this operation) <br />X New Application (Rule ].4.5) Amendment Application (Rule 1.10) <br /> Conversion Application (Rule 1.11) <br />Permit i1 M -_ __ ` (provide for Amendments and Conversions of existing permits) <br />The application For a Construefion rYfaterials Limited Impact (1 l0) Operation Reclamation Permit contains three major parts: (1 }the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum I, any sections of Exhibit 6.5 and Geotechnica] SUtbility Exhibit, as required <br />by the Office, and outlined in Rules 6. i, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit yow application, be <br />sure [o include one (1) corrmlete si¢ned and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum I, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1 /2" X <br />11" or 8 1/2" k 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 described below. <br />1. Aoulicant/ooerator or comnanv name (name to be used on certt7itl: S & S Serv i c <br />L I Type of organization (corporation, pa7tnership, etc.): S o l e P r o p r i e t o r sh i p <br />2. Oseratfonnarae(nlt.mirteorsltename): Lopez Quarry No, 2 <br />3. Permitted acreage (new or existin¢ site): 9 • $ permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 'focal Acreage in Permit Area ~_ acres <br />4. Fees: <br />4.1 New Application: $1 Oy4,00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125([1)): X719.00 application tee <br />4.2 Conversion Pee (from 1 IOd to 110 875.00 conversion fee (Rule 1. ] 1.2(2)) <br />5. PHtttarvcommoditie(sitobernitted: Sand & Gravel Soil <br />5.1 lncideNal cormoditie(s} to be mined: 1. / IbslTons%yr 2. / Ibs/Tons/vr 3, 1 IbsPCons/vr <br />4. ( 1baTons!yr 5. / IbslTons/vr <br />5.2 Antcipated end use of primary commoditie(s) to be mined: Road C O n s t rue t i o n <br />Anticipated end use of incidental conmioditie(s) to be mined: Surfacing and F i 11 <br />Office of Office of <br />Mined Land Reclamation Active and Inactive Mines <br />