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TATE OF COLORIADO <br />IVISION OF MINERALS AND GEOLOGY <br />epartment of Natural Resources <br />313 Sherman St., Room 215 C O L O R.A D O <br />enver, Colorado 80203 t) t v 1 s t O N O F <br />gone: (303) 866-3567 M I N E~ RA L S <br />4X: (303) 832-8106 G E O L O G Y <br />.~p*~~Tf .~.~n~~*~. xECIAFtATION•MINING <br />CONSTBUCTION MATERIAIGS SAFETY•SCIENCE <br />LIMITED labIPACT (110) OPERATION ai11 Owens <br />Governor <br />RECLAMATION PERMIT APPLICATION FORM Russe-- George <br />Executive Director <br />Ronald W. Cottony <br />Division Director <br />IECK O There is s File Number Already Assigned to this Operation Natural Resource Trustee <br />Permit # M - -_ (Please reference the file number currently assigned w this operation) <br />~„_ Ne~v Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (R.ule 1.11) <br />Permit # _ Ivy- - (provide for Amendments atxi Conversions of e~asting permits) <br />to application far a Construction Materials Limited Impact (110) Operation Reclamation Permit contains thmee major parts: (1) the application <br />rm; (2) Exhibits A J, Exhibit L, Addeadtnm I, atry sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and <br />alined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1 Xb); a~ (3) the application fee. When you submit your application, be sure to include one <br />co~up~l to signed and natarizad ORIGINAL a-nd one (1) copy oftlie completed application form, two (2) copies afExhibits A•J, Exhibit L, <br />ddeadum 1, and appropriate sections of 6.5 (t,,eoteclmical Stability Exhibit), as required, and a check for the application fee described under <br />~) below. Exhibits should NOT be bound yr in a 3-ring binder; maps should be folded to 81/2" X 11" or 81/2" X 14" size. To expedite <br />•ocessing, please provide the information in the format and order descnbeci in tlis form. <br />GENERAL OPERATION 1NFORIvIATION <br />Type or print dwrly, in the apalce provided, ALL information deslerl-bed belwv <br />Auulicant/ocetnttor or oomnanv name (natoe to be need on toermit): ~~r~]:-n-~^ e~~=~ <br />1.1 Type of organization (corporation, partnership, etc.): T.oc 1 ~ nvr~ r n m pgt <br />1.2 I.R S. Tax ID No. or Social Security Number: <br />Qnemtion name (Hirt. mine or site name): ~ 1 a r lr P <br />PerotiRted aereaae (ne~v or existin>< site): ~ _ 9 ~ permitted acres <br />3.1 Change in acreage (+) ~'~ <br />3.2 Total Acreage in Permit Area ~~ <br />• Fees: $1 , 2 5 8.0 0 <br />4.1 New Application: -'~-A94-8~- application fee <br />Amendtt~rent Fee (C.RS. 34-32.5-125(lT)): _ application fee <br />4.2 Conversion Fee (from 110d to 110$875.00 conversion fee (Rule 1.11.2(2)) <br />Prmtarv commodftie(s) to be meted: Sand C, r a v P 1 <br />5.1 Incidental commoditie(s) to be mined: 1. n / lbslTons/yr 2. / lbs/Tons/vr 3. / 1bsrTons/vr <br />4. / lbs/Tons/yr 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: County Road M a i n t e n a n c e <br />Anticipated end use of incidental commoditie(s) to be mined TT,L A <br />- -.. ~ r.m -- -` !`..1......1.. <br />