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<br />c-r? A ?-*- <br />DIVISION OF MINERALS AND GEOLOGY tII II111I I1t11?? ??? <br />Department ui Natural Resources <br />1313 Sherman 51., Room I IS <br />Denver, Colorado 80203 NOY 0 51001 <br />Phone: 4 3031 866.3567 tlYt <br />FAX: t 1031832-8106 Oivlsion of Minerals end catllolly <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />c <br />DIVISION O F 1 <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING-SAFETY <br />Bill Owens <br />Gtwernor <br />Greg E. Watcher <br />Executive Director <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application Rule 1.10 "h?l B. Long <br />( ?ivis:On Director <br />% Conversion Application (Rule 1.11) <br />Permit It lM__.?___p (provide for Amendments and Conversions of existing permits) <br />The application for a CmIrtiction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections ofExhibit 6.5 (Geatechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) om ete signed and notarized IVORY ORIGINAand four (4) copies of the completed I= <br />application form, five (5) copies of Exhibits A-S, Addendum I, 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, LL hiformation requested below. / <br />?1• a0 <br />!. Agnaipnt/ooerator or comnanv name (name to be used on X41: BACA COUNTY ,3Y <br />1. I Type oforganization (corporation, partnership, etc.): GOVSRM-MTAL ENTITY <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: #84-6000744 <br />2. gRemtion name (nit mine or site name): MMELL PIT #32 <br />ate'?• <br />3. Permitted acreage (mew or exist nar <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. )M: <br />9.12 permitted acres <br />30.88 acres <br />40.00 acres <br />4.1 New Application S1.875,99 application fee <br />4.2 New Quarry Application 42.325.00 quarry application <br />4.3 Milling Application (Non-DMO) 53.100.00 milling application <br />4.4 Amendment Fee 51.550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) SI.975.00 conversion fee <br />5. Primary eommodltle(s) to be mined; ROAD BED-IATERIAL <br />5.1 Incidental commoditie(s) to be mined: 1. IbgIgus/vr 2. 1 Ibs/fonsivr, <br />3. / lbs./ron-sM 4. / lb ons/vr 5. ! Ibs/1•ons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: WHEN ROAD MATERIAL l ' IS DEPLETED. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A <br />i <br />OF COLORADO