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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />~- - <br />CONSTRUCI'IONMATERIAIS SE'r ) ` LCO5 <br />REGULAR(112)OPERATION '1`I.~; ': L:np <br />COLORADO <br />D 1 V I a l O N O F <br />MINERALS <br />GEOLOGY <br />AECLANATION•NINING <br />fA,ETT4CIENCE <br />1313 Sherman St., Room 275 <br />Denver, Colorado 80203 <br />Phone: {303) 866.3567 <br />FAX: (303) 832-8106 <br />RECLAMATION PERIVIIT APPLICATION FORM <br />Bill Owens <br />Governor <br />CHECK ONE: There ie a File Number Already Assigned to this Operation <br />Russell George <br />Permit # Irv - ~~i •~-, (Please reference the Sle number currently assigned to this operation) F.c`u'ire bireccor <br />New A hcation ule 1.4.5 X Amendment A hcation ule 1.10 Ronald w. Cottony <br />._._ PP ~ ~ ) PP ~ ~ ) Division Director <br />_ Conversion Appication (Rule 1.11) Natural Resource Trustee <br />Permit # M - a o _ 0 ~) -^ (provide far Ameadments and Converalona of existing permits) <br />The application for a Constriction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2} Exhibits A-S, Addendum 1, any sections ofExlribit 6.5 (Geoteclurical Stability Exhibit; and (3) the application fee. When you submityour <br />application, be sure to include one (1) complete signed end notarized ORIGINAL and one (I) copy of the completed applicetionform,two (2) <br />copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, end a check for the application fee described <br />under Section (4) below. Exhibits should ~ be bound or in a 3-ring binder, maps should be folded to 8 112" X 11" or 8112" X 14" size. To <br />expedite processing, please provide the infomtation in the format and order descrbed in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, AI.L Information requested below. 11 <br />OI Ca, IQ Sw rosaP, irsc, Olaa <br />1. ADUlicantlocerator or comaaav name (name to be need on cermit): to n.I-e~ CoAn Panics of Mesa Coun{-y <br />I.I Type of organization (corporation, partnership, etc.): C o r ~o rg~i 0 n <br />2. Oceratwa Berne (Bit, mice or site name); {} n ~ trSo~ P ~'~" <br />3. Permitted acreage fnew or eriatine Bite): <br />3.1 Change in acreage (+) <br />3.2 Tote! acreage in Permit area <br />4. <br />I S 9.7$ permitted acres <br />a, l gig <br />l st, 8s a~g <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarry Application $2.906.00 qumry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Prlm arvcommoditie(s)tobemixed: Su^~ Cir4r <br />5.1 Incidentelcommoditie(s)tobemined: 1.Ovab~EJrF ~SaGGG 1bsrIl~/vr 2.Toeso.l~,000 1_ bs <br /> 3. / lbs/Tons{~ 4. / I <br />bs/Totvs/vr 5. / Ibs/Tons/vr <br />5.2 p <br />Antirdpatedenduseofprimarycommoditie(s)tobemined "bad ~Se- gAt~ CDnS}rwG-~lor~ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: F_~_ V eo}E1% f iol~ <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />