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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />D r? <br />1313 Sherman SL, Room 215 O <br />Denver, Colorado 80203 1 v ?( LO U CO L O N ID P <br />Phone (303) 8663357 CONSTRUCTION MATERIALS RECLAMATION <br />FAX: (303) 8328106 MINING <br />REGULAR (112) OPERATION SAFETY <br />RECLAMATION PERMIT APPLICATION FORM <br />Bill Ritter, Jr. <br />Governor <br />CHECK ONE: There Is a File Number Already Assigned to this Operation Harris D. Shennarr <br />Executive Director <br />Permit # M : (Please reference the file ntnnber currently assigned to this operati 9d w. Cattany <br />XXX New Application (Rule I A.5) Amendment Application (Rule 1.10) oivisloo Director <br />Natural Resource Trustee <br />Conversion Application (Rule 1.11) <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: (t) 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 sate to include one (1) ggMplete 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 (Geoteclmical Stability Exhibit, and acheck 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 l " 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 INFORMATION <br />Type or print clearly, in the space provided, ALL Information requested below. <br />Moffat County Board of <br />1. Applicant/operator or company name (name to be used on aermit): County Col]lII iss loners <br />1.1 Type of organization (corporation, partnership, etc.): Local Government <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreat=e (new or eadsdne site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />Clay Pit No.' 21 <br />18.498 permitted acres <br />0. acres <br />18.498 acres <br />4. Em. <br />4.1 <br />New Application <br />XXXXX 52,696.00 <br />application fee <br />4.2 New Quarry Application $3342.00 quarry application <br />4.4 Amendment Fee 52.229.00 amendment fee <br />4.5 Conversion to 112 operatiort(set by statute) 4% A conversion fee <br />5. Primary commoditle(s) t be mined: Clay <br />5.1 Incidental commoditie(s) to be mined: 1. N/A - lbs/Pons/vr 2. ! Ibs/Tons/vr <br /> 3. ! lbs/Tons/yr 4. 1 llull'ons/vr S. 1 lbs/rons/vr <br />5.2 Anticipated end use of primarycommoditie(s)tobe mined: Road Construction Materials <br />5.3. Anticipated end use of incidental commoditie(s) to be mined: N/A <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction . Durango Active and Inactive Mines