PERMFILE139800

• Permit No: M2003091
• IBM Index Class Name: Permit File
• Doc Date: 3/29/2004
• Doc Name: Approval Request for Well Permit from SEO
• From: Applegate Group Inc.
• To: SEO
• Media Type: D
• Archive: No

D DIVISION OF WATER RESOURCES
.NT OF NATURAL RESOURCES
3n St., Rm. 818, Denver, Colorado 80203
666-3581 For Official Use Onty
> PRIOR TO COMPLETING FORM
IT APPLICATION
NSTRUCTED AFTER DEC. 31, 1980

th Avenue; PO Box 215001
80221-0599

OPERATOR CONTACT (If different Than #2)
'nc.
PIT NAME Duckworth Pit
120th Avenue, Suite 200
80234-2728
DMG No. M-03-091

ITfS1:
!. Sec. 16 Twp. 2 ~ N. ^ S., Range 68 ^ E. ^X W. 6th P. M.
irface to be exposed: Acre. Number of Pits 2
20 Ft. Estimated depth to groundwater 5 Ft.
7. Estimated date to expose groundwater July, 2004 ; to complete mining Jul 2006
8. ATTACHMENTS: (Check which have been attached.)
(a) ~ Scaled map of pit area with range, township, & section clearly identified (REQUIRED).
(b) ~ Copy of the reclamation permit, if applicable.
(c) ^ Copy of pre 1/15/89 water conservancy dist. Or water user assoc. augmentation agreement, if applicable
(d) ~ Copy of proposed substitute water plan or augmentation plan application, if applicable.
(e) ^ Copy of court approved augmentation plan, if applicable. Case No.
(f) ^ Other

9. Detailed description of any use, other than evaporation, and method of diversion, rate of diversion, and annual amount of diversion
of any water withdrawn from the pond.
2.0 acre-feet for dust control• 22.1 acre-feet for moisture in mined material Dewaterin u 3600 m'

10. I (we) have read the statements made herein and know the contents thereof, and that they are true to my (our) knowledge.
(Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the second degree antl is
punishable as a class 1 misdemeanor.)
NamelTitle (Please t or poop
r
F/LA L ~, d ./~/r., ~.• e Signat Date
For Official Use Only
Court Case No. Div.Co._ WD Basin _ MD Use