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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of eSOUYCCS I IIIIII III (VIII VIII VIII VIII IIII IIII <br />1313 Sherman St St.., , Room 215 4 i C O L D R A D O <br />Denver, Colorado 80203 p t v t s t o of <br />t'hcne.: 1303) 866-3567 979188 6/25/2008 3:24 PM Linda Daley RECLAMATION <br />FAX; 1303) 832-81Q6 I of 7 PER R$36.00 D$0.00 Laplata County Clerk MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />Bill Riftor,)r. <br />ovrrnor <br />LI1VI1*1EI) IMPACT (110) OPERATION G <br />RECLAMATION PERMIT APPLICATION FORM Exccui; rv D. r? s D ir.x?or „ <br />xr:ir <br />Ronald W. Came,. <br />. - . Divislcm Dirtt'tt,r <br />CHECK ONE: There Is a File Number Already Assigned to this Operation Natural Ruwurcr Tn,:a - <br />Permit ht _ (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 i.l 1). <br />Permit # Iyt - (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: (])the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, anysections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by ( pp ' . the Office.. and outlined inRule5 6,1 6.2 6..3,6.5 and 1.6.2 l)(b)• and;;(3) the,a heation fee. When you submit your application, be <br />sure to include one (1) complete signed and notartred QRIGINAL and one (1) copy of the con rpletedappltcation form, two (2) copies <br />of Exhibits A=J, Exhibit L, Addendum 1, and appropriate s(ctrong of6.5 (Geotechaical Stability Exhibit), as required, and a check for <br />the application fee desortbecl under (4?ibelow, tExl?ibi,4sfsltR41?j NOT be bound or in a 3 ring binder, maps should be folded to 8 1/2" X <br />I 1 " or 8 1/2" X 14' size To expedite processing; 0,66provide-the unformadon int(te format andbr¢erEicscnbed in this forrtt <br />.; <br />t <br />GENE)?AL OPERATION INFORMt1TION <br />Type or prlnt.Oearly, to the space provided, ALL Information described below. <br />1. Applicant/operator or company name iname i' be used'on oernttt) L rt c?t-R 1--= ?h? ; ST 2 UC T) ?mil <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (nit; mine or site name): 1-04A? ` np_ ,, lyLr_s4 3086f ul S f n_ " <br />3. Permitted aerealie (new or ezistine site): permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 "Total Acreage in Permit Area % (I aMa'{`rJe' S acres <br />4. k ces: <br />5.1 New kpplicatiOn: 1,258.00 application fee <br />Amendsnent:Fee (C.R S ,34.32 5425(11)): 827.00 application tilt <br />4.2 Conversion Fee (from I lOd tot 10 Ag4.00 conversion fee. (Rule. 1. 11.2(2)) <br />5. Primary commoditle(s) <br />5.1 Incideirtal comnioditie?s) to be ii ?;ed -1 f - ibstrons/yr - 2..-. ` ./ Ibs/TgL1s )bs :f ons; yr <br />4 / ?b,Fr('ons/vr 5 IbsfloLts/yr <br />Anticipated end use .? _ ofpurnary carntnodttie.(s)tobrnuned.`;_ <br />ra*3 , <br />?nrtc.pdted end use of tnctder}tal cotntnodlhe(s) Ga be miac <br />c <br />MAC <br />C)ificc of - uiGcc ut --- -- <br />,t:ned Land Reclamation. Denver • Grand junction • Durango' Acti,c and lnjcti?,v Mine; <br />i7?rve? ?.•.??ss ,?.S??ctl ?P?cx.,r?, /?Sa ??Na ?8, Dv,ei9?Gc?. c? ?3r3a/