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® EXHIBIT I
<br />S~AT~ of
<br />coLor~~o
<br />D!V[51ON OF ttECLAMATION,`MINING'AND~SAFETY ` i :", ;~•'~ nc ~• . ', ~t t~. •tt~t t rn~,~~•, r"•~~~1:-
<br />Depattment of Nattttdt Resounoes f.:'!?f;f SJii}i:llt; ' ~~~~"ii3`tS i'`41 _~?
<br />i313ShermanSt.,Room21S 'rxi,"1,~;tit'tl.~;f,';~;Ct t~6; ;?,l?. :; ~; -
<br />a~nve~, Co)orado ao2o3 ~ , ._ ~ ~ ... r>,-~=.1 ~ r,±: l.l:? : ~r 7 ~~ t{} ~ c o 1_ o R A D o
<br />Phone: (303) 866-3567 !°'!4hri Y .i. `?:C ~ il(; D I V t S 1 0 N O F
<br />FAX: (303) 832-8106 '3(lC: r~ L.EwI:, , }:tit
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<br />~ ~••~ ~, RECLAMAT ON
<br />MINI N
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<br />CONSTRUCTION MATERIALS
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<br />LIIbiITED IMPACT (110) OPERATION BIII Ritter, Jr,
<br />Governor
<br />RECLAMATION PERMIT APPLICATION FORM Harris D. Sherman
<br /> Executive Director
<br /> Ronald W. Cottony
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<br />CHECK ONE: There Is a File Number Already Assigned M this Operation Dkislon Director
<br />Natural Resource Trustee
<br />Permit # . M - - _,_„ (Please reference the file number curnntly assigned to this operation)
<br />X l-1ew Applit~tlon (Rule 1.4.5) ~ Amendment Application (Rule t.10)
<br />Conversion Application (Rule 1.11)
<br />Permit # _ 1~1,,,- (provide for Amendments and Conversions of existing pertnits)
<br />The application for a Coasttvction Materials Limited Impact (110) Operation Reclamation Panmt contains three major parts: (1) the
<br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit t5.5 and Geoteehnical Stability Exhibit, as required
<br />by the Ofytce, and outlined in~Rules b.1, 6.2, 6.3, 6.5, and 1.6.2(lxb); and (3) the application fee. When you submit your application, be
<br />sure to include one (1) tzgrpplete sigged 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 (Geoteehnical Stability Exhibit), as required, and a check for
<br />the application fee described under (4) below. Exbibits should I~ be bound ar in a 3-ring binder; maps should be folded to 81/2" X
<br />1 l" 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 described below.
<br />1. Aaalicant/oagrator ?1C ~gmpOgv natrte (name to be used on aermitl: Dolores County Road D e ~t
<br />1.1 ,Type of organization (corporation, partnership, etc.): County G o y e r n m e n t
<br />2. Operation name [pit. mine or site name): P r i bb 1 e P i t
<br />3. )E'g~n tted acreage fnew or eaistina aitel: permitted acres
<br />3.1 Change in acreage (+) acres
<br />3.2 Total Acreage in Permit Area 7 acres
<br />4. Fees:
<br />4.1 New Application: ~1,25$L~ application fee
<br />Ametxirtumt F~ (C.R.S. 3A~-32.5-L25(Il)): S$Z7.OQ application fee
<br />4.2 Conversion Fee (from 110d to 110 x.00 conversion fee (Buie t.l 1.2{2))
<br />5. Primary commodiNe(s) to be mined: S t a n d s t o n e ,.~
<br />5. i incidental commodities) to be mined: I. ! 1bslTons/vr 2. / Ibs/I'onslvr 3. ! lbs/Tons/,~r
<br />4. ./ Ibs/Tons/vr 5. / lb~/~ons/vr
<br />5.2 Anticipated end use of primary commoditie(s) to be mined: D e e e m b e r 31 ~ 2 018 _
<br />Anticipated end use of incidental commoditie(s) to be trained: N/A _.._..__
<br />Uffice of Office of
<br />Mined Land Reclamation Denver • Grand )unction • Durango Active and Inactive Mines
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