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STATE OF COLORADO <br />IDIVISION OF RECLAMATION, MINING #NO SAFETY <br />Department of Natural Resources ?? /? <br />1313 Sherman St., Room 215 <br />, t i C J l? C O L O R. A D O <br />Denver, Colorado 8020311 t} t v I S I o h o r <br />Phone: (303) 866-3567 RECLAMATION <br />FAX: (303) 832-8106 `CONCC'I'ION 4iA''F,RiA.L;S M.1 N 1 NG <br />REGGI..AR (112) OPERATION SAFETY <br />NAo 'a 2009 RECLAMATION PERMIT APPLICATION FORM <br />DtviaiW of ReGL2matiopl, Bill Ritter, fr. <br />Governor <br />MAIN and Safety <br />CHECK ONE: There is a .File Number Already Assigned to this Operation Harris D. Sherman <br />Executive Director <br />Permit d/ iVi - - (Please reference the file number currently assigned to this operatiTgald W. Catreny <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />Natural Resource Trusttx-? <br />Conversion Application (Rule 1.11) <br />Permit (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 stare to include one (1) complete signed 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; maps should be folded to <br />8 1/2" X 1 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 INp0R,\4ATi0N <br />Type or print clearly, in the space provided, ALI, information requested below. <br />y? 5,t1?N1?? <br />1. Applicant/operator or company name (name to be used < <br />1.1 Type of organization (corporation, partnership, etc.): C. ?- ?? = r L` ?` `_! __-?----- <br />2. Operation name (pit, mine or site name): Z. 'a> eA.D <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage (•+-) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application. <br />4.4 Amendment Fee <br />4.5 Conversion. to 112 cyperation. (set by statute) <br />5. Primary commoditie(s) to be mined: few' i? ? L) '-:- <br />.........__...._.Ebs/:I:r?rls% r <br />5.1 Incidental. commoditie(s) to be mined: 1. 1JM._.. ......... <br />Z ?5 permitted acres <br />acres <br />Z 5 acres <br />t:2 696 0o4i application fee <br />5342,00 quarry application <br />S2,229.00. amendment. fee <br />$2,696.01 . conversion fee <br />2..__.._...__--- 1bs/'gns/yr <br />3. -_-- / Ibsrrons/y_r 4, _.........__...1___..__...__thsfI;ons%yr 5. -1.bs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: C!!'=l C _ <br />5.3 Anticipated end use of incidental commoditie(s) to be trained: t_?'? <br />Office of Office of <br />Mined Land Reclamation Denver • Grand )unction • Durango Active and Inactive Mines