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<br />DIVISION OF MINERALS AND GEOLOGY <br />Department rri Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Gllorado 80203 <br />Phone: (30!) 866.3567 <br />FAX: ( 1031 832.8106 <br />NIInItl1-07r-I?G= <br />NOV 0 S 2001 <br />Oivlsioa of Minerals Wagon, <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />c - <br />DIVISION O F 1 <br />MINERALS, <br />GEOLOGYI <br />RECLAMATIONI <br />MINING•SAFETY <br />RECLAMATION PERMIT APPLICATION FORM Bill Owens <br />CHECK ONE: New Application (Rule 1.4.5) <br />R Conyerslon Application (Rule 1.11) <br />Cnvernor <br />Greg E. Watcher <br />E Recutive orrector <br />Amendment Application Rule 1.10{?r`hael a long <br />( birlsion OrrecMr <br />Permit N M --25--- 019 _ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections ofExhiba 63 (Geatechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete signed and notarized IVORY ORIGINAL and four (4) copies of the completed hn <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 YLOT 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, Iik.?s iatormadion requested below. r <br />,3'f'l • <br />1. &=11canVeRgrator or company name (name to be used on permit): BACA COUffff 00 <br />I . l Type oforganization (corporation, putnership, etc.): GOVERNMTAL ENT JJ <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: - X84-6000744 <br />2. Operation name JRk, mine or site name): HMIKLL PIT 132 <br />3. Permkted acreage- (pew or el<istLg ttt : <br />3.1 Change in acreage (+) <br />31 Total acreage in Permit area <br />9.12 permitted acres <br />-- 30 - 88 acres <br />40-00 acres <br />4. f=: <br />4.1 New Application S1.875,99 application fee <br />4.2 New Quarry Application -22,325-00 25.00 Quarry application <br />4.3 Milling Application (Non-DMO) 11100-00 milling application <br />4.4 Amendment Fee S1"550.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) 51.875.00 conversion fee <br />5. Primary Commodltle(s) to b mined: ROAD BED MATERIAL <br />5.1 Incidental commoditie(s) to be mined: 1. - bst l onstyr 2. / lbs/ibnslvr <br />3. / lbs/Tonc/vr 4. / Ibs/Tons/w 5. / Ibst'onslvr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: )(M ROAD MATERIAL. !JS DEPLETED. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: 1A <br /> <br />OF COLORADO