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STATE OF COLOKAD0 <br />DIVISION OF RECLAMATION, MINING AN <br />Department of Natural Resources D SAFETY <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 COLORADO <br />ll l V I S I O N O C <br />FAX: (303).832-8106 CONSTRUCTION MATERIALS RECLAMATION. <br />1ZEGUL.,R (1.12) OPEIUTJON MINING <br />RECLAMATION U,IZiv ITAPPLICATION.F01ZnNI SAFETY <br />C H E C K ONE: ? There is a.File Number All•ead A ' <br />Bill RiUm, jr, <br />Governor <br />J Sslglle(i Lo UnS Opera ,tnon Harris D.. Sherman <br />tl.lis operati Diva t??? Director <br />Permit # ipyl _ ?? - Q q?,(plcase reference the file number currently assigned to Nip <br />New Application (Rule 1.4.5)' TAald w. cattany <br />Amendmegt Application (Rude 1.10) NaLtural Division Director <br />-Conversion Application (Rule 1.11) Resource trustee <br />Permit # M (provide for A.mendllnents,and.Con ' <br />yet <br />-sions of existing pernnits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Pcrlilit contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendunn 1, any sections of Exhibit 6.5 (Geo(eclnii.cal Stability Exhibit; and (3) the application fee. When yo1 <br />subunit your application, be sure to include one, (1) complete signed and Notarized ORIGINAL and one (:l) copy of the completed <br />application form, two (2) copies of);xhibits A-S Addencilun 1 aproriate the application fee described under Section (4) below. Exhibits phould NO.Ttbelbound or Gin a 3-ring binder; maps <br /> lsho??ldlbe folded to <br />8 1/2" X I I" 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 INFOIZIvIATION <br />Type of print clearly, in the space provided, ALL illfornnation requested belom <br />1 • Applicant/oper•ltol• or connpally n•une (11alile to be used oll permit: <br />1.1 Type of organization (corpoatioln, partnership, etc.): <br />2. Operation name (pit urine or site n•uu(?: ?! U A S L24?'N ?, _ l?/Stu E ?. <br />3. Permitted acrealye (nely or existilILT Site: <br />3:1 Change in acreage (I ) <br />3.2 'T'otal acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />11.4 . Amendment Fee <br />4.5 Conversion to 112 operation (set by sta(ute) <br />5. Primary co11)111oditie(s) to be milled: <br />- permitted acres <br />5 . lo.°I acres <br />2 . ?9 acres <br />521696.00 application fce <br />$3,342.00 quarry application <br />52.,229.00 alneudme ntfee <br />2L696.00 colnversign tec <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/Tons/yr 2. lbs/Tons/y_r. <br />3. / Ibs/Tons/vr 4. /. IbsfFolis/v? s. _ /. lbsfFons/vl' <br />5.2 Anticipated end use of primary commoditie(s) to be mined:?? <br />5.3 Anticipate(t emci use of.illcidcntal conlnlociil:ie(s) to be,llnined: <br />Office of Office of. <br />Mined Land Reclamation rlr.,rnror . C.rand hmrrir- . no- ......._i i.... _?.:. ... 1. 1:..,...