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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY R E CETED <br />Department of Natural Resources <br />1313 Sherman St., Room 21 s AUG 1 92003 <br />Denver, Cobrado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 Division at Minerals and Geology <br />FILE COPY CONSTRUCTIONBUTERIALS <br />(112) OPERATION <br />CHECK O1VE: There is a M NmnberAkeedy A ilped to thb Operadon <br />Pesmk # M o1Q43-A?4? (please re6m=w the 5fe numbercmu tly amgwd tD Ibis operation) <br />New Appliaatton (Roe 1.4.5) A>mdneat Application (Rnle 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M (provide for Ant miduients and Costverdons of ex6ting pemlits) <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />DECLAMATION <br />MINING-SAFETII <br />Bill Owens <br />eovemor <br />Greg E. Wamw <br />Executive Director <br />Ronald W. Canny <br />Acting Division Ohem <br />Tlu application for a Candruction Makdals RcgWw 112 Operation Roolaimstion Permit coaltaios three nts*parts: (1) the application form; <br />(2) Exbtbits AA Addendum 1, any sootions of Ed bit 63 (Cleotechnicol Stability Exblbit; and (3) fm application fee. When you subtakyour <br />application, be acne ID hWbWe me (1) gg=pl? sin dd mad notdoad IVORY ORj fi f ff , sod are (1) copy of the completed IM application <br />foam, two (2) copies a F.xhrbits A-S, Addendum 1, appropriate sections cf 6.5 (Geoteahnical Stability EAd'bit, and a cLeck for the application <br />fee deed order Sechon (4) below. Eabtbids sb=M NOT be bomd ar is a 3-i'mg bonder, macs dmuld be failed toS l2" X 11" or 8 l2" <br />X 14" size. To expedite pnooessiu& phase provide the infiamn tim in die foam at and order dascnbed in this form. <br />GErl>:RAL OPERATION INFORMATION <br />Type or print clearly, M the apace provided, I L Information r peated below. <br />1. Agpllcant/a?merator or comuanv name (name to be used on oermft): Baca County <br />1.1 Type of orpdZedon (corporation, P=Wersblp, etc.): <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: 270033560 <br />2. ODeratfon nUM (nit. aside or site name): <br />3. Permitted acreme (new or esMS site): <br />3.1 Charge in acreage (+) <br />3.2 Total acreage in Permit area <br />Hinds Pit # 35 <br />4_ FM: <br />4.1 Now Application <br />4.2 New Qmu7y Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />permitted acres <br />acres <br />100 <br />acres <br />52344.00 application fete <br />$2,06.00 gaavy application <br />11938.00 amendment fee <br />52344.00 conversion fee <br />5. PdW=Tg mrgodit g to be mined: r_, ve i Sand <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/1 ons/vr 2. / lbs/Tons/yr <br />3. / /tToas/yr 4. / lib ' lam 5. / IbalTonsLyr <br />5.2 Anticipated end use ofprimary commoditie(s) to be mined: When supply id depleted. <br />5.3 Andckwuod end use of incidental comawditic(s) to be mined: N/A