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DIVISION OF MINERALS AND CEOIOGY <br />Depatlme>t d WWrai Resouroef <br />~~ ~ <br />1313 5hemun St, Room ~t s C O L O RA D O <br />pC~+ DIVISION OF <br />pl,a„e j3p3~ ~ ~~3 CONSTRIICTTON MATERIAIS i-6GO.o~~~ ~~ M I N Fz RA L S <br />FAX: (303) 832d101i 1tEGIILAR (i1Z) OPE1ATION ~~~ G E O L O G YY <br />~CLAILIATIONPERMIT APPLICATION FOAM•~ 2 2 20~ ~ RECLANATIOM•NINING <br />fAfETT•fCIENC! <br />~'' o20p5~ 07 <br />Oivisian of tuiinera~. and Gea1PgY Bea t)aens <br />l;aemor <br />CHECK ONF.: There L a Fik Number Already AniEned to thb OpentbD aaEEen eeelaf <br />Permit # M -_ _ _ (Please reference the file ntmtber tanretttly assigned to this operation) FY°Oai`e Di'~0! <br />aonaw w. ~v <br />New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) pht~ qua <br />Conversion Application (Rule 1.11) Natural Iteawrca rnafx <br />Pertuit # M -_ _ (provide for Amendments and Converebos of existing permits) <br />The application for a Construction Materials Regular 1 l2 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, arty sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fce. When you submdyour <br />application, be sure to include one (1) cortlplete silmed and notarved ORIGINAL and are (1) copy of the completed application farm, two (2) <br />copies of Exhibits A-S, Addendum 1, appropriate sections of6.6 (Geotechnical Stability Exhibit, and a check for the application fee described <br />under SectioD (4) below. Exhibits should ~T_>x txxmd a io a 3-ring border, maps should>x folded to 8 12" X I t"or 812` X 14"sine. To <br />expedite processing, please provide tbe infomation in the format and order described in this form <br />GENERAL OPERATION INFORMATION <br />or print ekariv. k the <br />information requested below. <br />1. Llpplkantlolrerator orcomoaDV Dfrme (name to tie used oD txrmifl: /V~ ~~A(/~L .T/(/C . <br />~/pL~ <br /> 1.1 Type of organization (corpLxatioD, partrEership, etc.) : f~r // <br />Pc~clTlGi7 <br /> <br />2. <br />Otre <br />ratioD Dame (Dit, mine or site Dame): G <br />~.O~~I/JG7~ / , <br />~/'C///e~ ~iT /(/O, .3 <br />3. Permitted aercatee (Dew or eiiatint! aite): ~_~ permitted acres <br /> 3.1 Change in acreage (+) acres <br /> 3.2 Total acreage in Permit area /3~- G acres <br />4. Fees: <br /> 4.1 New Application $2.344.00 application fce <br /> 4.2 New Quarry Application $2.906,1X1 quarty application <br /> 4.4 Amendment Fee $1.938.00 amadment fee <br /> 4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Prim srv arommoditk(a) to be mined: ~~d . r ~ <br />6.1 Ine:idental commoditie(s) to be mimed: 1 rlib~i/ea - ~SODO lbs~on~vr z f1Fb6/.?s/5ooo lbw s~Avr <br />3. / Ibs/fons/~ 4. / ibs/fon.}(}2 5. / lbslfonsA+r <br />5.2 Anticipated end use of primary commoditie(s) to be mined: C~iJS~Y6CG~/~~/~ IY/~~p.Y/id~~~ <br />5.3 Anticipated end use of incidental mmmoditie(s) to be mined: ~lli?C~.S'Gtl ,~~ /~"i 9YL~//l~lS <br />q(fice of lNfke d Colorado <br />Mined land Reclalrutlon ANve and InaGive MinES Geologkal Survey <br />