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i -aoo3-dj3/ <br />ptVIS10N OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: 1303) 866-3567 <br />FAX: (3031832-8106 <br />STATE OF COLORADO <br />r ALE COPS RECEIVED ~~ <br />,; ~~a74I~~®I4,N~7 SEP 152003 MINERALS <br />CONSTRUCTION MATEBiAIS <br />Oilrision al Minerals and <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: _~ There is a Ft7e Number Already Assigned to this Operation <br />Permil.#~f~~~ (Please reference the file nttmber cttcrently assigted to this operation) <br />~t// New Application (Role 1.4.5) / _ Amendment Application (Rule I.10) <br />~Converaion Application (Rule 1.11) <br />Petmit # M - (provide far Amendments and Conversions of existing permits) <br />IT,EOLOGY <br />RECLAMATION <br />MINING•SAFETY <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive DlfeCtor <br />Ronald W. Cattany <br />Acing Division Director <br />The application for a Conshnction Materials Regnlaz 112 Operation Reclaoaatiam Pe®it contains three majorpaAs: (1) the application form; <br />(2) ExbtbIIs A-S, Addendmm I, any sections ofExbibII 65 (GeotecLnical Stability Exhibit; and (3) fire application fce. When yon submityonr <br />application, be sine to include one (1) campy s~~'eced and notarncd IVORY ORIGIlVAI, amd o~ (I) copy of the completed Ivo-y application <br />form, two (2) copies ofExlubits A-S, Adtlea&tm 1, appropriate sections of 6.5 (Geotechmcal Stabrbt' y ExLrbit, and a check for the application <br />fee described under Secfioa (4) below. Exhibits sbrxdd NOT be bo®d or in a 3aing binder, maps should be folded to 812" X 11" or 812" <br />X 14" slue. To expedite pxocessing, please provide the information is the fomrat and order descnbedm this Egan. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, In the span provided, ALL information requested below. . <br />I. AonlicanUoner~stor or comnanv name (nameto be aced on nermftl: M D(~ ~~ 1 LI MC57-D )1fe 1.U-, 1 IdC./ <br />l .l Type of araani7ation (corporation, partnership, etc.): C6 R ~D R WTI D N <br />1.2 IZt.S. Tax ID. No. or Social Security Nttmber: <br />2. Operation name (oi4 mine or site name): <br />3. Permitted acreage (new or esisting site): <br />3.1 Change in acreage(+) <br />3.2 Total acreage in Pernt:K area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />rtn~l pt'_R Mornr/T/~Inl ~ Rpvi°~ <br />S. Ptimarv commoditie(s) to tx cooed: Ch(~ta 1/eL <br />5.1 Incidental commoditie(s) to be mined: 1. ND!/G Ibs/Tons/vr <br />3. / Ibs/Tons/vr 4. <br />5.2 Anticipated end rise of primary commoditie(s) to be mined: , <br />7~ permiii[ed acres <br />~"~ acres <br />p ~ q~ acres <br />( T2.344.00 _am2licaynnSeel~ <br />$2.906.00 quarry application <br />51.935.00 amendmeaz fee <br />52.344.00 conversion fee <br />2. / Ibs/I'ons/vr <br />S. ! lbslI'ons/vr <br />r!a.JsTa~urTDa/ r~'lraTei <br />5.3 Anticipated end rise of incidental commoditie(s) to be mined: <br />