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~~~~ OF COLORADO DIVISION OF MINERALS AND GEOIt]GM Uepanmern of Natural Resources l3 t 3 Shemun St., Room ~! 15 Denver, Colorado BO?03 ~ D I v 15 1 0 N o f Phony: 13031 a6h-3567 RECEIVED MINERAL 5 FAR 1303) 83?-8106 & GEOLOGY MAR 2 ~ 2000 MENINGMSAFETY CONSTRUCTION MATER1y~00 O(Minerab 6 Ge010gy Bill Owens LIMITED IMPACT (I10) OPERATION Governor Greg E. Walther RECLAMATION PERMIT APPLICATION FORM Executive Dnenar Michael B. Long Division Duecror CHECK ONE: X New Application (Rule 1.4) Conversion Application (Rule 1.1 I ) Amendment Application (C.R.S. 34-32.5-110) Permit # vet -_-_ _ (provide for Amendments and Conversions of existing permits) The application fm a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parrs: (1) the application form; (2) Exhibits A-],Exhibit L, Addendum 1, arty sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application fee. When you submit your application, be sure to include one (1) complete sieved and notarized IVORY ORIGINAL and one (I) copy ofthe completed Ivory application form, two (2) copies of Exhibiu A-], Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), az required, and a check for the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to 8 12" X 11" ar 8 12" X 14" size. To expedite processing, pleaze 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 described below. 1. ApnlieaoUooeratororcompanvname(nametobeusedoopermitl: Hardscrabble, L.L.C. 1.1 Type of organization (corporatioM pa~ership, etc.): L . L . l; . 1.2 I.R.S. Tax ID No. or Social Security Number: 2. Operation name(oit.mineorsitenamel: Phillips Ranch Property Gravel Pit #2 3. Permitted acreeee (new or existinn site): q - q permitted acres 3.1 Change in acreage (+) acres Total Acreage in Permit Area q . 9 acres 4. Fees 4.1 New Application: $875.00 application fee Amendment Fee(C.R.S.34-32.5-125(11)): 575.00 application fee 4.2 Conversion Fee (from I I Od to 110 75.00 conversion fee (Rule I.I 1.2(2)) 5. Primary commoditie(s) to be mined: Sand Gravel 5.1 Incidental commoditie(s) to be mined: I. / Ibslfons/vr 2. ! Ibs/fons/vr 3. / Ibs/fons/vr 4. / Ibs/rons/vr 5. / Ibs/fononstruction Aggregates - 5.2 Anticipated end use o(primary commoditie(s) to be mined: 5.3 Anticipated end use of incidental commoditie(s) to be mined: W/A All Phases