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STATE OF COLORADO <br />DIVISION Of RECLAMATION, MINING AND SAFETY <br />Depanment of Na[mal Resources <br />7373 Sherman St, Room 21 S <br /> <br />Demer <br />Colorado 60203 C O L O R A D O <br />• <br />Phone: f3o31 B663a6i o i v t s t o v o r <br />RECLAMATCON <br />Fnx: t3o31 a32-at o6 M I N I N G <br /> -&- <br /> SAFETY <br /> CONSTRUCTION MATERIALS <br /> LIMITED IMPACT (110) OPERATION sin rnve<,: <br /> Gorernor <br /> RECLAMATION PERMIT APPLICATION FORM Russell George <br /> En~eNive Oirecfor <br /> Ronald W'. Czltzny <br />CHECK ONE: There is a File Number Already Assigned to this Operation ova:ion ofrector <br /> Natural Resource Truslne <br />Pem»t # M -` _ _ (Please reference the file number currently assigned to this operation) <br />/ New Application (Rule 1.4.5) _ Amendotent Application (itule 1.10) <br /> Conversion Application (Rule 1.1 t ) <br />Petmit if 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: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit G.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 simed and notarized ORIGINAL and one (I) copy ofdte completed application form, hvo (2) copies <br />of Exhibits A-!, Exhibit L, Addendum I, and appropriate sections of 6.5 (Geotechnical Stability F,xhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-riag binder; maps should be folded to 8 1!2" X <br />11" or 8 l/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 io[ortnation described below. <br />1. ApplicanUouerator or com~anv name (name to be used on mermitl:+~,~Il t' hl C~ ,I, ~ <br />1.1 Type of organization (corporn[ion, partnership, etc.): (111 ~ ~U )!~ ~~ I V <br />2. Operation name (pit, mine or site Hamel: J I 0 ~ ~.t{%IL M A~YI (A ~ RQ.`~Ur(P~ >QY.PlA <br />3. Permitted acreagelnew or existing sitel: q. ~ permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 'total Acreage in Pemtit Area q . °~ acres <br />4. Fees: <br />4.1 Ncw Application: ~ $1 094,00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(11)): $719.00 application fee <br />4.2 Conversion Fee (from I SOd W 110 X875_00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: ~ ~~ _g„U t~ _ <br />5.1 Incidental commoditie(s) to be mined: 1. / IbslToncbr 2.. / Ibsll'ons/~r 3. __-_ % !bs/I'ons%vr <br />4. _ l~lbsrTons/vr 5. p / Ipbsffotn~s/Yr I A <br />5.2 Anticipated end Ilse of primary commoditie(s) to be mined: I I_ I V ~i' 1Y~ ~ ~I~ h ~ I (. `~ I~ U( me~ <br />Anticipated end use of urcidentat commoditie(s) to be mined: ____,_,_______~._ __._-__. <br />Office of - Office of <br />Mined Land Reclamation Active and Inactive Mines <br />