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rl STATE tPCOLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />1h7,.vtmem of Natural Re-,ources <br />1113 Sherman St., Room 21 S <br />Denvve. Colorado 80203 <br />Phone- i W 1186h-3567 <br />FAX: (14).f1 83-1-81116 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Rov Romer <br />Governor <br />lames S. Lochhead <br />Esecutive Ottector <br />Michael B. Long <br />Division Director <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />X Conversion Application (Rule 1.11) <br />Permit N M - 93 - 088 - (provide for Amendments and Conversions of <br />existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains <br />three major parts: (1) the application form; (2) Exhibits A-S, Addendum 1, any sections of <br />Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete signed and notarized IVORY ORIGINAL and four (4) <br />copies of the completed Ivory application form, five (5) copies of Exhibits A-S, Addendum 1, <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee <br />described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps <br />should be folded to 8 1/2• X 11' or 8 1/2" X 14• size. To expedite processing, please provide <br />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 />1. ALimlicant/operator or company name (name to be used on permit): -- - <br />-BACA COUNTY ROAD & -BRIDGE DISTRICT #1 <br />1.1 Type of organization (corporation, partnership, etc.): COUNTY <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: 84-6000744 <br />2. Operation name pit, mine or site name): GUNKEL PIT NO. 31 <br />3. Permitted acreage (new or existing site): 9-025 permitted acres <br />3.1 Change in acreage (+) 150,975 acres <br />3.2 Total acreage in Permit area 160,000 acres <br />4. Fees: <br />4.1 New Application S1,875.00 application fee <br />4.2 New Quarry Application S2,325.00 quarry application <br />4.3 Milling Application Won-0140) $3,100.00 milling application <br />4.4 Amendment Fee S1,5-50.00 amendment fee <br />4.5 Conversion co 112 operation (set by statute) $1,875.00 conversion fee <br />5. Primary commoditie(s) to be mined: GRAVE? <br />5.1 Incidental coalmodicie(s) to be mined: 1. _ Ibs/Toms/v- <br />2• / lbs/Tons/yr 3. / lbs/Tons/vr <br />4. / lbs/Tons/yr 5. / lbs/Tons/vr <br />5.2 Anticipated end use o! primary commoditie(s) to be mined: UNTIL PERMITTED ACRES <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: DEPLETED