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<br />DIVISION OF MINERALS AND GEOLOGY <br />OLV-191ment ui Natural ResrwrceS <br />131 3 Sherman St., Room 21 S <br />Denver, C010rado H0203 <br />Phone: 130!)t166.356i <br />FAX: ( 1031832.8106 <br />NIN <br />MIInINI? <br />NOV 0 S 2001 <br />Divlsios of Minerals end Geology <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />DIVISION O F <br />MIN ERALSi <br />GEOLOGY <br />RECLAMATION <br />MINING-SAFETY 1 <br />RECLAMATION PERMIT APPWCATION FORM oil' owem <br />CHECK ONE New Application (Rule 1.4.5) <br />A Conversion Application (Rule 1.11) <br />Cnrernor <br />Creq E. Wakher <br />ExeCWive Daectp <br />Amendment Application Rule 1.10{? icnael o. Long <br />( bivision Director <br />Permit # `l,?-__ 019 _ (provide for Amendments and Conversions of existing permits) <br />The application for a Consbuction Materials Regular 112 Operation Reclamation Permit contains three major pans: (1) the application form; <br />(2) Exhibits A-S. Addendum 1, any sections ofExhibk 6.5 (Geotechnical Stability Exhibit, and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete si®ed and notarized IVORY ORIGINAL and four (4) copies of the completed Loa: <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 PLOT be bound or in a 3-ring binder, maps should be folded to <br />8 1/2" X 1 l" 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 cleanly, ht the space provided. AU information requested below. <br />AMcanVoR1rator or comeanv name (name to be used on pgrmk): BACA COMM <br />1.I Type oforganization (corporation, partnership, etc.): GOVERIUMTAL EM rlx <br />1.2 I.R.S. Tax I.D. No. Of Social Security Number: /84-6000744 <br />2. Operation name (21L mine or site name): MUNDELL PIT 132 <br />3. Permitted acreage- (new or exist ea! site): <br />3.1 Change in acreage N <br />32 Total acreage in Permit area <br />4. fg: <br />- 9. 12 permitted acres <br />30-$8 acres <br />40-00 acres <br />4.1 New Application S 1.875,QQ application fee <br />4.2 New Quarry Application 12.325.00 quarry application <br />4.3 Milling Application (Non-DMO) 53.100.00 milling application <br />4.4 Amendment Fee S1-550.Q0 amendment fee <br />4.3 Conversion to 112 operation (set by statute) S1,975,00 conversion fee <br />5. jrimarv commodige(s) to be mined: ROAD BED MATERIAL <br />5.1 Incidental commoditie(s) to be mined: I. Ibs/fonshrr 1. f Ibs/ronsfvr <br />3. lbs(roni& 4. / lb ons/vr S. If Ibs/rons/vr <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: NZA <br />i <br />OF COLORADO