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<br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St.. Room 21 S <br />Denver, Colorado 80203 <br />Phvne:(3031866-356i <br />FAX: t 1031 832.8106 <br />miummimn: <br />NOV 0 52001 <br />Division of Minerals andceolopy <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />f <br />DIVISION O F <br />MINERALS1 <br />E <br />GOLOGY <br />RECLAMATION <br />MIND SAFETY <br />ails Owens <br />Cnver"or <br />Greg E. Watcher <br />Executive Orrector <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10t00.1 rLtoong <br />r <br />A Conversion Application (Rule 1.11) <br />Permit q - (provide for Amendments and Conversions of existing permits) <br />The application for a Comtruction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S. Addendwn 1, any sections ofExhibk 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sinned and notarised IVORY ORIGINAL and four (4) copies of the completed JIM <br />application form, five (5) 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 1/2' 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 INFORMATION <br />Type or print dearly, In the space provided, Ai information requested below. i& h"!7141 <br />,3101 • oD <br />1. AMlicant/ooermtor or company name (name to be used on WMW: BACA COUNW <br />1.1 Type oforganization (corporation, partnership, etc.): GOVERNMENTAL ENTr'rv <br />1.2 I.R.S. Tax I.D. No. Of Social Security Number: #84-6000744 <br />2. gReration on-me (pit mine or ske name): MUNDELL PIT #32 <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />32 Total acreage in Permit area <br />4. fg: <br />9.12 permitted acres <br />3, 09_ acres <br />40-00 acres <br />4.1 New Application 11-875-9a application fee <br />4.2 New Quarry Application 52325.00 quarry application <br />4.3 Milling Application (Non-DMO) 13.100.00 milling application <br />4.4 Amendment Fee 11.550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) S I-975.00 conversion fee <br />5. Primary commodltie(sl to b mined: ROAD B4D MATERIAL <br />5.1 Incidental commoditie(s) to be milled: 1. lbsiTonstyr 2. ! tbsffonslvr <br />3.-- -- / Ibs/ons/vr 4. / IbsIT2ns/vr S. / IbVTons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: WM ROAD MATERIAL !JS DEPLETED. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br /> <br />OF COLORADO