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STATE OF COLnRAnn <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAY: (303) 832-8706 <br />aooq - oat <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (I10) OPERATION <br />RECLAMATION PERMI'T' APPLICATION FORM <br />CHECK ONE: <br />COLORADO <br />D 1 V I S 1 o N O r <br />RECLAMATION <br />MINING <br />SAFETY <br />Bill Ritter. Jr. <br />Governor <br />Harris D. Sherman <br />Exrxmive Directo- <br />Ronald W. Cattanv <br />Division Director <br />There is a File Number Already Assigned to this Operation Natural Resource Trust<e <br />Permit M = - -? (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Nfaterials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-.T, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be <br />sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application forth, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 112" Y <br />1 l" or 8 1i2" 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 clearly, in the space provided, ALL information described below. <br />1. Ap plicant/operator or company name (name to be used on permit): _ Walsenburg Sand and Gravel Company <br /> 1.1 "Type of organization (corporation, partnership, etc.): Corporation <br />2. Op eration name (pit, mine or site name): WSG-Hribar <br />3. :Permitted acreage (new or existin?: 9.99 - permitted acres <br /> 3.1 Change in acreage <br /> acres <br /> 3.2 "Total Acreage in Permit Area 9 <br />99 <br /> . <br />_ <br />- acres <br />4. Fees: <br /> 4.1 New Application: $1,258.00 application fee <br /> AnrLndment Fee ((°.R.S. 3=1-32.5-12501.1)): 983MM application fee <br /> 4.2 Conversion Fee (from 1101d to 110 S1,258.0 conversion tee (Rule 1..11.2(2); <br />5. Primary commoditie(s) to be mined: .-_Sand .-__ ... gravel, --_-borrow <br />5.1 Incidental commoditie(s) to be mined: I. lbsi"Tons/yr 2. ibsiTons r 3. ?Ibs Tort, <br />4. 1bs <br />----------7 ons_yr 5. --------------- ----(hsTcui_s:-yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: .,_,_..._Specif icat-ion aggregates <br />Anticipated end use of incidental comet oditie(s) to be rnined: -- -- - - - <br />Office of - Offices of <br />tilined land Reclamation Denver • Grand Junction • Durango /active and Inactive Mines