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T ~ 1 <br />N~-Z002~ 0'1'i <br />STATE OF COLORADO <br />DIV15fON OF MINERALS AND GEOLOGY <br />Department of Nalura) Resources <br />t 37 3 Sherman SA, Room 215 <br />Denver, Colorado 80203 R EC El V E D <br />Phone: (303) 8b63567 <br />fAX:(303)932-8706 <br />CONSTRUCTION MATERIALS JUL 162002 <br />'~ 1LE COPY SPECIAL (1I1) OPERATION ~irision of Minerals and GaolagY <br />FOR S~A~~I ~~~~ON PERMIT APPLICATION FORM <br />DIVISION OF <br />MIN&RALS <br />GbOLOGY <br />REGLA MATION <br />MINING•SAfE7Y <br />BBI Owens <br />Governor <br />Gseg E. Wakher <br />Fxttutive Director ' <br />Mlchxl B. long <br />Division DIlectw <br />application fox a Coasmtction Materials Special 111 Operation Reclamation Permit containsfota major parts: (d) the application form; <br />Exhibits A I, Addendum 1, aad any gections of Exhibit 6.5 (Gwtechnicat StabiliryExbibit), as required by the Office, and outlined in <br />x 6.1, 6.2, 6.3, 6,5, and 1.6.2(1)(b); (3) the appliwdon fee; (4) thePexformanu Warranty andifregnsed aFinancial Warranty When <br />submit your application, be sate to include ono (1) completed sieved aad notarized IVORY ORIGINAL and one (1) copy of the <br />pletedIVORY application form, two (2) copies of Exhitits A L, Addendum 1, appcopriateseetlons of Exhibit 6.5 (Geoteehnieal Stability <br />ihit), as required, a checkfor the application fee described under (4) below, and the fully executed Performance Warranty aad Financial <br />ranty, if required. Hxhibits should NOT be bound or in 3-ring binders; maps should be folded to 8'h" X 1l" or 8'/z" X 14" size. To <br />xtite processitiR, Please provide the infortnatiaa in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print dearly, in the space provided, all information described below. <br />Aonlicantlooerator or company name (name to be used on the oetmit): <br />].1 Typo of organization (corporation, partnership, etc.): <br />1.2 IRS. Tax ID No. or Social SectnityNurnber: <br />Onerationname(oit.mineorsitename): Van Valkenburg Pit <br />Permitted acreaae• ~ 30 Permitted Arses <br />New Apallcadon• <br />a7sl.oo Application Pee <br />P~imarycotnmaditie(sltobemiaed: flock ~ Sand Gravel <br />~emeofotvnertothesnrtaceotafeectediand: William Van Valkenburg <br />Nameafotvnertotbesabsnrfaceristhtsofatfectedbtnd: William Van Valkenburg <br />Tl~e of mfnioe operation; X Surface ~ Undag[DUnd J To-siN <br />Location information: The cente of the area where the majority of mining will occur: <br />COUNTY: Jackson <br />PRINCIPAL MERIDIAN (check one): X 6th (Colorado) _ ,_ l Odt (New Mexico) _ Ute <br />SECTION (write number): S 23 <br />TOWNSHIP (write atunber and check direction): T 6 X North _._ _ South <br />RANGE (write pumber and check direction): R 81 ,East X .West <br />QUARTER SECTION(checkone): X NE _NW _SE _SW <br />QUARTERIQUARTERSEGTION (check oae): _ NE _ NW _ SB ~ SW <br />OENHRAL DESCRIPTION: (miles and dset=tioa from nearest towB and the approximate elevation) 2 2 M i 1 e s <br />southwest of Walden Co, on State Hwy 14 ELev.- t. <br />