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<br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />J kINUTED IMPACT OPERATION (110(2)) <br />5-100 01 a Sa??+ RECLAMATION PERMIT <br />i0xn9 2n APPLICATION FORM <br />CHECK ONE: ZNew Application (Rule 1.4) Conversion Application (Rule 1.11) <br />Permit # M '- n30 (provide for conversions of existing permits) <br />M_ 9.06's - 039 <br />COLORADO <br />DIVISION Of <br />RECLAMATION <br />MINING <br />SAF tETY <br />Bill Ritter, Jr. <br />Governor <br />Harris D. Sherman <br />Executive Director <br />Ronald W. Cattany <br />Division Director <br />Natural Resource Trustee <br />'t'he application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A-J, any required sections of Exhibit S and Geottxhnical Stability Exhibit, as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure to inchide one (1) signed and <br />aotariz original and one (1) copy of the application form, two (2) copies of Exhibits A-J, appropriate sections of 6.4.19 Exhibit S and 6.5 <br />(Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should no be bound <br />or in a 3-ring binder; traps should be folded to 8 1!2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information <br />in the format and order described in this form <br />GENERAL OPERATION INI+'ORMATION <br />Type or print clearly, in the space provided, all Information described below <br />1. Appiicant/overator or company name (narllle to be used on the Permit* VENMi2 C_,P 00,e CGS! /NC, <br />1.1 Type of organization (corporation, partnership, etc.): ceAR A7-1oN --7CmLoAA-va <br />2. Operation name fait. trine or site name): ?MMA L o4a evs* / RCI <br />3. Permitted acreage, (new or existing site): <br />d• is 3 permitted acres <br />4. Fees: <br />4.1 New Application <br />4.2 Amendment Application (from 1.10(2)) <br />4.3 Conversion Fee (frorn 1 Iod to 110(2), (Rule 1- 11,2(2)) <br />$1,006.00 application fee <br />$1.725.00 conversion fee <br />5. Primary conurt itie(sI to be mined:. /!? ! O ; n??,r ?- ___._-------- -- <br />14- X/ <br />G L C <br />6. Name of owner to the surface of affected land: /i ? <br />7. Name of owner to the subsurface ri¢hts of affected land: nf1v X71, /y 1/d9,/ 1- -1-C- <br />9. Tvpg of mining operation: ,._ _ Surface ?_I;nderground _ In-situ RECEIVED <br />[JUN 0 6 2008 <br />Division ui mt;uiamatiorf, <br />Mining and S@ft <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines