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C~~~ <br />STATE ORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY ' .~M ~' ~~~©l ~ <br />Department of Natural Resources <br />1313 Sherman St., Room 215 ~~ Vi,tGct (~4 C O L O R A D O <br />Denver, Colorado 80203 ` u t v t s t o N o f <br />Phone: (303) 866-3567 I ~'"`~ '~°~ C.de(~ RECLAMATION <br />FAX: (303) 832-8106 MINING <br />- &- <br />SAF ETY <br />CONSTRUCTION MATERIALS <br />Bill Ritter, 1r. <br />LIMITED IMPACT (110) OPERATION Governor <br />Harris D. Sherman <br />RECLAMATION PERMIT APPLICATION FORM Executive Director <br />Ronald W. Cattany <br />Division Director <br />CHECK ONE: There is a File Number Already Assigned to this Operation Natural Resource Trustee <br />Permit # M - - -_ (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # 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 6.5 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)(b); and (3) the application fee. When you submit your application, be <br />sure to include one (1) comulete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, 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 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 desfcr--ibed below. <br />1. Applicantloperator or company name (name to be used on permit): U~~ <G~ /eS ~ C <br />1.1 Type of organization (corporation, partnership, etc.): ~ r r t % l ` <br />2. Operation name (pit. mine or site name): ~e~IrhQeiT°Z" ~~ <br />3. Permitted acrea¢e (new or existine site): „~ ~ ~~ p ~ permitted acres <br />3.1 Change in acreage (+) ~ ~` ~a acres <br />3.2 Total Acreage in Permit Area MAR 2 A~ 2008 9, ! acres <br />4. Fees: ~ci~:mation, <br />~ivtsson ota ~ SafetY <br />4.1 New Application: tJlining 1 258.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): 827.00 application fee <br />4.2 Conversion Fee (from 110d to 110 1 258.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: ~nc~ l~~ <br />5.1 Incidental commoditie(s) to be mined: 1. ~~' lbs/Tons/fir 2. / lbs/Tons/vr 3. / lbs/Tons/yr <br />4. / ibs/Tons/vr 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ~,~it7J/f)~~^c~G1A-n <br />Anticipated end use of incidental commoditie(s) to be mined: ~/~ <br />Office of Office of <br />Mined Land Reclamation Denver Grand Junction Durango Active and Inactive Mines <br />