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YI - 2oo5-Do Z,/ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY -~ <br />Department of Natural Resources <br />1313 Sherman St., Room 2t i / C O LO RAD O <br />Denver, Colorado 80203 / DIVISION O F <br />Phone: (303) H66.3i67 - _ ",. _„ 1Jl I N ~ A L <br />FAx: (303) e3z-aloe G E O L O G Y <br />' ~ - 0.E ClAMATION•M INING <br />SAf FTY•ECIENCE <br />CONSTRUCTION MATERiAi R / <br />LIMITED IMPACT (110) OPERATION d aiu Owen: <br />Governor <br />RECLAMATION PERMIT APPLICATION FORM Russell George <br />Executive Director <br />Ronald W. Cattany <br />Division Direcor <br />CHECK ONE: There is a File NtFmber Already Assigned to this Operation Natural Resource Trustee <br />Perznit # M -_ _ _ (Please reference the file number currently assigned to tkris operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # ~-~ -_ (provide for Amendments and Conversions of existing permits) <br />The application fora Construction Materials Limited Impart(I10)OpezationReclamationPermitcontainsthreemajorparts: (1)theapplication <br />form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the ice, and <br />outlined in Rules 6.1, b.2, 6.3, b.5, and 1.6.2(I)(b); and (3) the application fee. When you submit your application, be sure w include one <br />(1) complete siP,Fted and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of Exhibits A-J, Exhibit L, <br />Addendum 1, and appropriate sections of 6.5 (Geotechnicat Stability Exhibit), as required, and a check for the application fee described under <br />(4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1!2" X 11" or 8 1!2" X 14" size. To expedite <br />processing, please provide the information in the format and order described in this form. <br />OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br /> <br />1.1 Type of organization (corporation, partnership, etc.): a l (~ 1 E T <br />].2 I.R.S. Tax ID No. or Social Security Number: / / <br />2. Operation name (pit, mine or site Hamel: r~~/I I,C ! F_ l ~ (~ j?Y] <br />3. Permitted acreage (new or eaistina sitel: <br />3.1 Change in acreage (+) <br />3.2 Total Acreage in Petrnit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34-32.5-125(II)): <br />4.2 Conversion Fee (from 110d to 110.,$~~8~75~.0~0~~co~nversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(sl to be mined: ~4~i <br />permrtted acres <br />acres <br />~. 9 acres <br />$1.094.00 application fee <br />$719.00 application fee <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs(fons/~ 2. ! IbslTans,'vr 3. ! ibs/1'ons/vr <br />4. / Ibslfonsfvr 5. ! 1bs/Tonsivr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~IJYf~/S~ ~/~'(~7~ O n <br />Anticipated end use of incidental commoditie(s) to be mined: f,~/lV' <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />