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III lIIIIIIIIIIIIIII ~a,3~~.~ <br />STATF, OF COLRADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Depa«ment of Natural Resources <br />1313 Sherman SC, Room 21 i <br />Denver, Colorado 80203 D I v f 5 1 0 N O <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS M I N E RA L <br />FAX: (303183?-8106 REGULAR (112) OPERATION S` <br />RECEIVED G E O L O G' <br />/RECLAMATION PERMIT APPLICATION FORM / R E C L A M A T I O <br />V ~'~'~ O ~ ZOO2 Mf NING•$AFET <br />Bill Owens <br />Division of Minerals and Getll~Ql'nor <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Greg E. Wal<her <br />Permit # M -_ _ - (Please reference the file number currently assigned [o this operation) Executive Director <br />Michael B. Long <br />X New Appbca[ion (Rule 1.4.5) _ Amendment Application (Rule I.10) Division Director <br />Conversion AMMpplication (Rule 1.1 l) <br />/Yermit # M -/SN z Q~_ (provide for Amendments and Conversions of existing pemrits) <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhrbits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhrbit; and (3) the application fee. When you submit your <br />applicatioq be sure to include one (1) complete sired and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder, maps should be folded to <br />8 1/2" X 11" or 8 1/2" 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. An//a6cautlooerator or comoanv name (name to be used on permit): <br />,N7estern Mobile Southern, Iric., a subsidiary of Lafarge North America <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />1.2 I.RS. Tax I.D. No. or Social Security Number: <br />2. Operation Dame fait. mine or site Hamel: ~/Beeman Pitt #1 <br />3. Permitted acreaee (new or ezistin¢ skel: <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit azea <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Appfieation <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: Sand Gravel <br />45 permitted acres <br />acres <br />45 acres <br />$2 344.00 application fee <br />$2.906.00 quam application <br />$1938.00 amendment fee <br />$2.344.00 conversion fee <br />Fill Material <br />~.1 Incidental commoditie(s)to be mined: 1. N / A Ibs(Tons/vr 2. / lbs/1'oos/vr 3. / !bs(TonshT <br />4. / Ibs/Tons/vr 5. / Ibs/Tons/vr <br />~.2 Anticipated end use of primary commoditie(s) to be mined: Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />