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STATE OF COLORADO <br />DIVISION Of RECLAMATION, MINING ANb SAFETY <br />Department of Natural Resources <br />7373 Sherman St., Room 2I5 <br />Denver, Colorado 80203 C O L O R A D O <br /> <br />Phone: 1303) 866-356: DIVISION O r <br />RECLAMATION <br />FAX; (303) 832-8106 M I N I N G <br /> - Sc - <br /> SAFETY <br /> CONSTRliCTION MATERIALS <br /> LIMI'1'Ell IMPACT (I10) OPERATION sill Owens <br /> Governor <br /> RECLAJIATION PERMIT APPLICATION FORM Rufuu George <br /> Exrrutive Director <br /> Ronald W. Cattany <br />CHECK ONE: 'There is a File Number Already Assigned to this Operation oivlsmn olrecsor <br /> Namrai Resource Tmslee <br />Pemlf # M -_ <br />; _ (Please reference the file uuinber currently assigned to this operation) <br /> , <br /> New Application (Rule 1.4.5) ~ Amendment Application (Rule 1.10) <br /> Conversion Application (Rule 1.11) <br />Permit t! M -_~ __ _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (I) the <br />application form; (2) Exhibits A-J, F.,xhibit I„ Addendum I, 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, G5, and LG.2(1)(b); and (3) the application tee. When you submityowapplication, be <br />sure to include one (t) complete sinned and notarized ORIGINAL and one (1) copyofthe completed application form, nvo (2) copies <br />of Exhibits A-J, Exhibit L, Addendum I, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as requved, 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 lit" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL, OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Applicant/operator or company name (name to be used on oermitl: ~~ ~~ ~,~~ 1 <br />1.1 Type of organization (corporation, partnership, etc11.): -~[~V~ Vr~ t 10 __ <br />2. Operation name (pit, mine or site name): ~P(t11~~) l)(.lV~r (~ . <br />3. Permitted acreage (new or existing site): ~ __ permitted acres <br />3.1 Change in acreage (~{-) acres <br />3.2 Total Acreage in Permit Area ~~ acres <br />4. Fees <br />4.1 Naw Application: ~ I q.Q4,00 application fee <br />.Amendment Fee (C. R.S. 34-32,5-125(II)): ~ ~,(t(Qd --- $71900 application fee <br />4.2 Conversion lee (fmm I IOd to 110 X75_;__00 conv~~e~~r~~si„„on..~~~,,fee (Rule 1.11,2(2)) f <br />5. Primarvcommoditie(s}tobemined:~1~ U ~(`~_~C~~ltlQ_~rr~i gYQ'Y~r ~(1(l( <br />5.1 Incidental commodities} to be min '~~ / ~! IbsPI'ons/vr 2. / Ibs~rl'onsyr 3. ___ 1 U Ibs/fonsrvr <br /> <br />52 Anticipated end use of primary commoditie(s) to be mined: <br />Anticipated end use of incidental commoditie(s) to be mined: <br />5. ! Ibsi fons~ , <br />_-_-I~a~ Y°~T__ <br />-..-~I l A T 1(1 ---------- <br />Office of <br />Mincxl Land Reclamation <br />Office of <br />Active and Inactive lrtines <br />