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Ill CAF <br />DIVISION OF MINERALS AND GEOLOGY C OLJRADC? <br />lIl I1111II111I11 <br />Del)aament ai Natural Resources 999 _ <br />171 ! Sherman $1., Room 215 <br />Denver, CaloradO 80203 NOV D 5 2 0 0 1 D I V I S I O N Of <br />Phune: FAX: ( tall 1 R t1;22.$.81(1IpG bi M IN &RA L S <br />FAX: ( Oivtaioa of Minerals gall Geology <br />GEOLOGY <br />N <br />CONSTRUCTION MATERIALS R E C L A MSAA T F I E O 7 Y <br />REGULAR (112) OPERATION M I NI N G• <br />RECLAMATION PERMIT APPLICATION FORM Bill Owens <br />Governor <br />Greg E. Watcher <br />Executive Orrector <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application Rule 1.10?tichaet s. Long <br />( bivision Director <br />A ConYerslon Application (Rule 1.11) <br />Permit # lei (provide for Amendments and Conversions of existing permits) <br />The application for a Constructim Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections ofFxhibit 6S (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sinned and notarized [YORY ORIGINAL and four (4) copies of the completed JyM <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 I I" 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, AU information requested below. Re. <br />r <br />1. &Wlicant/onemtor or comoanv name (name to be used on Dermit): BACA COON'1'Y , 3y4r• 00 <br />1.1 Type oforganization (corporation, partnership, etc.): _ VERNIMENTAL ENT 111 <br />1.2 I.R.S. Tax I.D. No, or Social Security Number: #84-6000744 <br />2. Ouemtion name (21t mine or site name): K=KLL PIT 132 <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />9.12 permitted acres <br />30.88 acres <br />40.00 acres <br />4. fM: <br />4.1 New Application 11,975,00 application fee <br />4.2 New Quarry Application S2325.00 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) S1,375,00 conversion fee <br />5. Primary commoditie(s) to b mined: ROAD BED 4ADJRIAL <br />5.1 lncideaml commoditie(s) to be mined: 1. Ibs/I•ons/vr 2. / Ibs(T2ns/vr <br />3. / IbstTons 4. / Ibsaltns/vr 5. 1 Ibs/Ponstyr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: WHEN ROAD MATERIAL !'IS DEPLETED. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A