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TATE OF COLOWO <br />DIVISION OF MINERALS AND GEOLOGY RLCEWED <br />Department of Nawrel Resouroea <br />1313 Shemwn St., Room 215 AUG i 91003 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 pivision at Minerals and Gaolo(n <br />FILE COPY CONSTRUMON MATERIALS <br />REGULAR (112) °PI ATZo14FORM <br />FOR S'CANNIA <br />CAECK t?NE: Them b a FSo Nandw Ah+eady Aadped to thk Operation <br />Penmit # M .c 3- 4 (Please rdumoo the 51e number am a* -god to this operation) <br />New Application (Rink 1.4.5) Amendment Application (Rnle 1.10) <br />Conversion Application (Rub 1.11) <br />Permit # hi - (provide for Amendments and Cenverdons of muting pear s) <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING-SAFETY <br />Bill Oweru <br />Governor <br />Greg E. Waldw <br />Evecutiva Director <br />Ronald W. Camay <br />Acting Division Of e= <br />The application for a Construction Maoesials RegWw 112 Operation Reclamation Permit cams three msjorpatts: (1) the application form; <br />(2) Fathbibs A-%% Addendum 1, any sections of FA%it 6.5 ((3eoWinical StablTq Ebit; ad (3) tba application fee. When, you submit your <br />application, be sure b fi dode one (1) comaft siaa®d and notaziaed IVORY ORIGIIcfAi, and one (1) copy of the completed hW application <br />form, two (2) copies ofEAMIs A-S, Addwibum 1, appmpriate sections ai6.5 (GeoOeohmcal Stability F.adubit, and a chock for the application <br />fee desmAled wader Section (4) below. Rd edi aboald NOT be bond ar m a 3-n* binder, maps sbmid be fokW IDS 12" X l l" or 8 1/2" <br />X 14" size. To expedite processing, plem provide the mboamatkn is d to b mat and order doscnbod in this fnann. <br />CIE IERAL OPERATION INFORMATION <br />Type or print clearly, In the apace provided, ALL information requested below. <br />1. A22lE9mt/2a0or or comnow namme (name to be used on permit): Baca County <br />1-1 Type of argaaizsbion (oorpomtion, partnw9hip, etc.): <br />1.2 LR.S. Tax I.D. No. or Social SamrW Number: 270033560 <br />2. Operation name (nit, M&I or site name): <br />3. Permuted acrem (new or existing site): <br />3.1 Chap in acreage (+) <br />3.2 Total screage in Permit area <br />4. Feg <br />permitted acres <br />acres <br />100 <br />gales <br />4.1 Now Application 52.344.00 application fee <br />4.2 New Quarry Application $2,_906.00 quarry application <br />4.4 Amendment Fee 31.938.00 amendment fee <br />4.5 ConverAoa to 112 operation (set by su me) 52344.00 conversion fee <br />5. Primary commod-Will to be mb>bed: Gy j Saud <br />5.1 Incidental ciammoditie(s) to be aimed: 1. lbs/Tons/vr 2. / lbs/T <br />3. 4. / lba/fona/vr 5. / ibdTonsAT <br />5.2 Anticipated end use of primary commoditie(s) to be mined: When supply id depleted. <br />5.3 A> od and use of kcidenU? commoditie(s) to be mined: N/A <br />Hinds Pit # 35