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ECEIVED CONSTRUCTION MATERIALS REGULAR (112) OPERATION ~/ MAY 0 9 2005 ~ RECLAMATION PERMIT APPLICATION FORM Division ~f Minarets and Geology CHECK ONE: There is a File Number Already Assigned to this Operation Permit # M - -_ (Please reference the file number currently assigned to this operation) New Application (Rule 1.4.5) Amendment Application (Rule ].10) ConverMsion Application (Rule 1.11) t' Permit # M -~~J~~ ~~ (provide for Amendments and Conversions of existing permits) The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 65 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of Exhibits A-Q Addendum I, appropriate sections of 65 (Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be Colded to 8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, ALL information requested below. Applicant/Operator Or Company name (name t0 be used on permit): COUlSOn EXCavattng Co..1nC. 1.1 Type of organization (corporation, partnership, etc.): Corporation 1.2 I.R.S. Tax I.D. No. or Social Security Number: 2. 3. Operation name (pit, mine or site name): Permitted acreage (new or existing site): 3.1 Change in acreage (+) 30 permitted acres acres 3.2 Total acreage in Permit area 4. Fees: 4.1 New Application 4.2 New Quarry Application 4.4 Amendment Fee 4.5 Conversion to 112 operation (set by statute) 5. Primary commoditie(s) to be mined: Sand Gravel 5.1 Incidental commoditie(s) to be mined: 1. - Ibs/Tons/vr 3. / Ibs/Tons/vr 4. / Ibs/Tons/vr 5.2 Anticipated end use of primary commoditie(s) to be mined: Sold as Sand and acres $2,344.00 application fee $2,906.00 quarry application $1,938.00 amendment fee $2,344.00 conversion fee 2. / Ibs/Tons/vr 5. / Ibs/Tons/vr 5.3 Anticipated end use of incidental commoditie(s) to be mined: