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M~ 2ot~(o~Q~~~-- <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />RECEfVED <br />APR 2 6 ~ <br />~irkioo of Minerakataf Geology <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M -_ _ _ (Please reference the file number currently assigned to this operation) <br />% New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -_ -_ (provide for Amendments and Conversions of existing pemrits) <br />The application for a Constmction Materials Limited hnpact (I 10) Operation Reclamation Pemrit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />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 <br />sure to include one (1) complete siffied and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1 /2" X <br />11" or 8 1J2" X 14" size. To expedite processing, please provide the information in the format and order described in this fonn. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Aoalicantlooerator or comoanv name (name to be used on permit): M M'M~ar~t+e+shSQ <br />1.1 Type of organization (corporation, parhtership, etc.): ~1 or~neri~; <br />2. Operation name (pit, mine or site name): YN~YY1YPl~nr~nerT4t(O G yn.VC, ~1 ~, <br />3. Permitted acreage (new or eaistine sitel: Q.q permitted acres <br />3.1 Change in acreage (+) (~. ~ acres <br />3.2 Total Acreage in Permit Area ~' . q acres <br />4. Fee <br />4.1 New Application: 1$ .094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): 719.00 application fee <br />4.2 Conversion Fee (from 110d to 110 $875.00 conversion fee {Rule 1.11.2(2)} <br />5. Primary commoditie(s) to be mined: S0.hd YtAVt~ Yrov.~ <br />5.1 Incidenta] commoditie(s) to be mined: 1. ! lbs/Tons/vr 2. 1 lbsll'ons/vr 3. ! ]bslTons/vr <br />4. / lbs/Tons/vr 5. / Ibs/Tons/n <br />5.2 Anticipated end use of primary commoditie(s) to be mined: 1D - (5 GCArS <br />Anticipated end use of incidental commoditie(s) to be mined: <br />