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o EXHIBIT I <br />STATE OF COLORADO <br />DiVISiON OF RECU4MATION, MINING ANO SAFETY <br />17epartmentofNaturatResources Tetstri.~tneil~ ~.~3aii F'~7~? <br />1313 Sherman St., Room 215 ~ ;?t}t~tuititl.b~:;;~,ii 0[~ :;i 1 ~3:? ~-~ <br />benver,Colorado80203 i~?-1.1.-?t_ll]~ ~~ l~l~e•'r7 ptn. <br />Phone: (303) 8titr3567 F'~~ ~ T 1 ? 1, ttl~f <br />FAX: (303) 832-t3t06 0(JC: f"EES , i~lft <br /> ilC~' Loot: 3'?1 F'~?se 3:~? - 33`~ <br /> LnRTI'n RAhi6QLF`H <br /> CLEfit: ~ FiEt~OF1Jir~ <br /> CONSTRUCTION MATERIALS <br />LIMITED IMPACT (I10) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />COLORADO <br />D I V t 5 l O N O F <br />RECLAMATION <br />MINING <br />._ &._._ <br />SAI=ETY <br />Bill Ritter, Jr. <br />Governor <br />Harris D. Sherman <br />Executive Director <br />Ronald W. cottony <br />Division Director <br />Natural Resource Trustee <br />Permit # - M - - :,_, (Please reference the file number currently assigned to this operation) <br />X 1\few Application (Rule 1.4.5) <br />Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # ,~I_,- (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 int Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submityour application, be <br />sure to iactude one (I) comp f etc sig•_ned 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 {Geotecbnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Bxblbits should ~~ be bound or in a 3-ring binder; maps should be folded to 8 1/2" X <br />11" or $ 112" 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. Ap plicant/opgrator or company name (name to be axed on permit): D o 1 o r e s County Road Dept . <br /> 1.1 Type of organization (corporation, partnership, etc.): County G o v e r n m e n t <br />2. Op eration name fait. mine or site name): P r i b b l e P i t <br />3. Permitted acreage fnew or eaistlnt: site): permitted acres <br /> 3. i Change in acreage (+) acres <br /> 3.2 Total Acreage in Permii Area 7 acres <br />4. Fees: <br /> 4.1 Mew Application: 1$ ,ZS$.00 appficatiott fee <br /> Amendment Fee (C.R.S. 3-0~-32.5-125(Il}): '7.00 application fee <br /> 4.2 Conversion Fee (from t 10d to 110 ~,2.25$.QO conversion fee (Rule 1.11.2{2}) <br />S. Primary commoditie(s) to be mined: S t a n d s t o n~ <br />5. t Incidental commoditie(s) to be mined: I . / lbs/Tons/vr 2. / lbs/Tons/vr 3. / IbsCl'ons/vr <br />4. ! Ibs/Tons/vr S. / Ibs/Tonslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: December 31 ~ 2 018 _ <br />Anticipated end use of incidental commodirie(s) to be mined: N/ A _.._. ,..~. _.__..... <br />Office of Office of <br />Mined i.and Reclamation Denver • Crarx! junction • Durango Active and Inactive Mines <br />