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1# 0 r4 STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 COLOR-ADO <br />Denver, Colorado 80203 DIVISION C F <br />Phone: (303) 8663567 CONSTRUCTION MATERIALS MINERAL S <br />FAX: (303) 832-8106 <br />REGULAR (112) OPERATION ??(?? 'GEOLOGY <br />RECLAMATION PERMIT APPLICATION FORM AE S A FE TY I S C IE N C E N G <br />Bill Owens <br />Governor <br />CHECK ONE: _ There is a File Number Already Assigned to this Operation Russell George <br />Permit # M - - -_Q15?- (Please reference the file number currently assigned to this operation) Executive Director <br />Ronald W. Cattany <br />New Application (Rule 1.4.5) Amendment Application (Rule L I0) Division Director <br />Conversion Application (Rule 1.11) Natural Resource Trustee <br />Permit # -o 6 -i W, <br />aprovide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form, <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit, and (3) the application fee. When you submityour <br />application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) <br />copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee described <br />under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11 " or 8 1/2" X 14" size. To <br />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 requested below. <br /> <br />I . Applicant/operator or company name (name to be used on permit): ,9ACA ?-? <br />COO 1 ? <br />1.1 Type of organization (corporation, partnership, etc.): Z,0cAL G,-0V r <br />2. Operation name (pit, mine or site name): US K PIT- 7j* <br />3. Permitted acreage (new or existing site): l 3 /. permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit area y. 1 1 3 acres <br />4. Fees: <br />4.1 New Application $2344.00 application fee <br />4.2 New Quarry Application $2.906.00 quarry application <br />4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2.344.00 conversion fee <br />5. Primary commoditie(s) to be mined: A IV RA V;:- L 4?84 , (••11 G- <br />5.1 Incidental commoditie(s) to be mined: I . lbs/Tons/yr 2. / lbs/Tons/yr <br />3. / lbs/Tons/vr 4. / Ibs/Tons/vr 5. / lbs/Tons/VT <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ?D A Q & l )1 LQ J/Vd> M AML? AL <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: RoA (v -C-o <br />office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey