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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 C U L O R.A. D O <br />Denver, Colorado 80203 D I t' 1 5 1 0 N o f <br />Phone: (3031866-3567 RECLAMATION <br />FAX: (303', 832-8106 CONSTRUCTION MATERIALS MINING <br />REGULAR (112) OPERATION -&- <br />RECLAMATION PERMIT APPLICATION FORM SAFETY <br />Bill Rirfer, Jr- <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation Harris D. Sherman <br />Executive Director <br />Permit ## 1.1 -_? (Please reference the file number currently assigned to this operatiTA, l '3 1W. Car;anv <br />V/ New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />Natural Rmourre Trus!•.•e <br />Conversion Application (Rule I.11) <br />Permit # M__. (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 <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) con2pletesigned and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) 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; Wraps should be folded to <br />8 1/2" X 1 I " or 8 1/2" X 14" size. To expedite processing, please provide the infortation in the format and order described in this form. <br />GENERA.I.. OPERA'T'ION INFORMATION <br />Type or print clearly, in the space provided, AIL information requested below. <br />1. Applicant/operator or company name (name to be used on permit): ??LtGtluS r 1'??y iUCc 'SS )2MS <br />I.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existing site,-): <br />3.1 Change in acreage (•I•) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 Nckv Application <br />4.2 Ne.v Quarry Applicatiot?. <br />4.d Arn n irnent lee <br />,l 5 CA-riverstou to 11.2 opera#totr (set by statute") <br />5. Primary contuaoditie(sl to be tnine:d: <br />5. j Incidental coniniod:itic(s) to be mined: 1. -__.._....... _Ihs_f o»:sryr <br />permitted acres <br />acres <br />C1 acres <br />$2,696.00 application fee <br />$3,342.00 quarry application <br />$2 229.OO0_ amendment. tee <br />.. ?,e(?e1,b.£40 conversion fee <br />2 i lbsA`ons/vr <br />3. Ibs/ Tonsiyr 4.._._.._.....__.. '-----.----.. __.Ihs(T'ons yr 5• _.._.._---------'...--------.._-_ lbsl_l-Uns!yr <br />5.2 Anticipated end use of primary corruttoditic(s) to be mined: --_RJAU._L--._.-_.----_--•-_-..._ ..................-..-------_-_--...._...-_.... ........ <br />5.:3 Anticipated end use of incidental commoditie(s) to be mined: <br />Office of Office. of <br />dined land Reclamation Denver • Grand junction • Durango Active: and Inactive Mines