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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 i . 5 <br />Denver, Colorado 80203COPY <br />Phone: (303) 866-3567 tiv <br />FAX: (303) 832-8106 a?CUNS'T'RUCTION MATERIALS <br />®Y e&'c0?k'al? REGULAR (.112) OPERATION <br />JUJi on 'IN4,'CLA.MATION PERMIT APPLICATION FORM <br />CO LO FLAD0 <br />D 1 V I S 1 0 N O F <br />RECLAMATION <br />MINING <br />SAFETY <br />Bill Ritter, Jr. <br />Govemor <br />CHECK ONE: There is a File Number Already Assigned to this Operation Harris D. Sherman <br />Executive Director <br />Permit # M (Please reference the file number currently assigned to this operatia4gald W. cattanv <br />X New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />Natural Resource Trustee <br />Conversion Application (Rule 1.11) <br />Permit # _ M (provide 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 <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 112" X 11 " 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 1N17ORMATiON <br />Type or print clearly, in the space provided, NLL information requested below. <br />Applicant/operator or company name (name to be used on permit): Western Gravel LLC <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />2. Operation name (pit. mine or site name): <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (-1-) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4-2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion. to -,2 operation. (set by statute <br />5. Primary commoditie(s) to be ruined: Gravel <br />WRC Gravel Pit <br />5. t Incictentat comr.:ociitie(s) to be mined: 1 2 5 0, 0 0 0 <br />3. _ i lbsfrons & 4. lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road Base_ <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />191 .83 permitted acres <br />acres <br />191 .83 acres <br />$2,696.00 application tee <br />53,342.00 quarry application <br />$2,229.00 amendment fee <br />52,696.00 conversion fee <br />2 .._ _ ?.? ibsf_ 1'onsivr <br />5. lbs/Tones <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and inactive Mines