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<br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY G/ R AE CETED <br />Department of Natural Resources <br />AUG 19 2003 <br />'Denver Colorado 80203 215 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 piyision of Minerals and G OW& <br />FILE COPY CONSTRUCUON NATERUM <br />FOR SCANNINGLAZ 0 ERBWAPM APMCATI[ON FORM <br />CHECK ONE: There Is a Me Number Ahvady Assigned to this Operation <br />Permit # M 43-6g4J (Please refereltce the Ile number amenity assigned to this operation) <br />x- New Application (Mlle 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M- - (provide for Amendments and Conversions of adsting permits) <br />Hinds Pit # 35 <br />The application for a Conshuctlion Mateaisis Regular 112 Operation Reclamsti m Permit calitaans dues ma3orparts.. (1) the application form; <br />(2) EXb%its A-S, Addendum 1, any sections dExbl'bk 6.5 (Geawhitical Stability EA t; and (3) the application fee. When you submit your <br />application, be sure to include one (1) templet 8404 and nolstized IVORY ORIGINAI. and one (1) copy of the completed k application <br />form, two (2) copies ofExb bits A-S, Addendum 1, appropriate sections of 6.5 (Geoteohaical Stability EAdbit, and a click for the application <br />fee destusbed wader Sec ion (4) below : FAibAff should NOT be bound arm it 3-ring hinds , maps should be folded OD S 1)2" X 1 l" or 8 1/2" <br />X 14" size. To expedite pmoessing, please prvi de the infummalion in the format and order described in this form. <br />GEMMAL OPERATION INFORMATION . <br />Type or print clearly, In the space provided, ALL information requested below. <br />1. Agaftat/oBeratororcomigmucame(nametobeused onnermf ): Baca County <br />1.1 Type of orgsmzatinm (corporation, partnership, etc.); <br />1.2 LRS. Tax I.D. No. or Social Security Number. 270033560 <br />2. Operation name (nit. M&e or site name): <br />3. Permitted acreage (new or exbftg site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />DIVISION OF <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MINING-SAFETY <br />Bill Owens <br />Governor <br />Corn E. Watcher <br />Executive Director <br />Ronald W. Catrany <br />Acting Division Director <br />permitted acres <br />acres <br />100 <br />acres <br />4.1 New Application. 52.344.00 application fee <br />4.2 New Quarry Application 52.906.00 gtuary application <br />4.4 Amendment Fee 51.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2344.00 conversion fee <br />5. P jgiar,Lcommoditle(al to be mined: r_,-n.re 1 Sand <br />5.1 Incidental c=rnuoditie(s) to be mined: 1. _ - Ibs/1 ons/vt 2. / lbigons/yr <br />3. 4. / lbs/1' a/vr 5. / lbsiTonshT <br />5.2 Anticipated end use ofprimarycommoditie(s) to be mined: When supply i# depleted. <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N/A