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<br />III IIIIIIIIIIIIIIII ~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Nawral Resources <br />131 3 Sherman Sl., Room 215 <br />Dem-er, Colorado 80203 <br />Phone: (3031 866-3567 <br />FA%:13031 832-8106 <br />OR`G-1N A~ <br />RECE'"~~ <br /> <br />CONSTRIICTION MAT8RI~1Q0 H~ •,..„~, .. - ~ -~ <br />RBGIILAR OPERATION (112) <br />RBCLANATION PBRMIT APPLICATION FORM <br />CHECK ONE: " New Application (Rule 1.4.5) <br />~~ 4~j0 <br />II~~ <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Roy Romer <br />Governor <br />lames 5. Lochhead <br />Executive Direttor <br />Michael B. long <br />Division Director <br />Ameadment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # _- - -_ (provide for Amendments and Conversions of <br />existing permits) <br />The application for a Regular 112 Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical <br />Stability Exhibit; and (3) the application fee. when you submit your application, be sure to <br />include one (1) complete sinned and notarized IVORY ORIGINAL and four (4) copies of the completed <br />ivory application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 <br />(Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) <br />below. Exhibits should not be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" <br />or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and <br />order described in this form. <br />--------------------------------------------------------------------------------------------- <br />--------------------------------------------------------------------------------------------- <br />GENERAL OPERATION INFORMATION ryL GJ 7- ~,~,( p <br />Type or print clearly in the space provided the information requested below. <br />--------------------------------------------------------------------------------------------- <br />--------------------------------------------------------------------------------------------- <br />1. Applicant/operator or company name (name to be used on permit): <br />(3+~ EXCRVi4T(N~ )n1C. <br />1 .1 Type of organization (corporation, partnership, etc.) : C:UKP'oKl}'61ON <br />1. 2 I.R.S. Tax I.D. No. or Social Security Number: ~~-DHD13~a <br />2. o peration name (pit, mine or site name) : C'l+ROI ANN PlT <br />3. Permitted acrea ge (new or existing site) ~r0 permitted acres <br />3. 1 Change in acreage (+ or -) D acres <br />3. 2 Total a creage in Permit area ~Or~ acres <br />4. Fees: <br />~ <br />4 .1 New Application 51,875.00 application fee <br />4 .2 New Quarry Application 52,325.00 quarry application <br />4 .3 Milling Application (Non-DMO) 53.100.00 milling application <br />4 .4 Amendment Fee $1,550.00 amendment fee <br />4 .5 Conversion to 112 operation ( <br />se <br />b <br />y s <br />tatute) <br />t 51,875.00 conversion fee <br />5. Primary ~ <br />~ <br />~~ <br />~ <br />t <br />commoditie (s) to be mined: 1RNL1 / ~~..~EL g~ O~ ~ yR <br />5 .1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr <br /> 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br /> 4. / lbs/Tons/vr 5. lbs Tons r <br />5. 2 Anticipated end use of primary commoditie(s) to be mined: O CIDf~b`CQOCf10i~ <br />5. 3 Anticipated end use of incidental commoditie(s) to be mined: <br />