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9104/2009 14:53 9702475104 DMG DURANGO OFFICE PAGE 06/16 <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />STATE OF COLORADO <br />RECEIVED <br />1313 Sherman St„ Room 215 <br />Denver, Colorado 80203 <br />AUG 1'3 2 <br />Phone:(303) 866-3567 <br />FAX: (303) 832-8106 DIVISign 8i Minerals end Genlagy <br />DELIBERATIVE CONSTRUCTION MATERIALS , <br />PROCESS COPY LIMITED I11±i,PACT (110) OPERATION <br /> <br />11ISCARD AFTER USw RECLAMATION PERMIT APPLICATION FORM <br />`? - 0-6-0z-0R'7 <br />NK: M. New Application (Rule 1.4) <br />D ANGO <br />OFFICE <br /> <br />01VIS10N <br />MJNERA <br />GEOLO <br />RECLAMATi <br />MINING-SAP <br />$ill Owens <br />Governor <br />Greg E. Watcher <br />Executive Director <br />Michael 8. Long <br />ColtverXIon Application (Rule DMon Director <br />Amendment Application (CA-S. 34-32.5-110) <br />Permit # -M--- _-- (provide for Amendments and ConversioA.g of eadsting permits) <br />The application ,for a Construction Materials Limited Impact (11,0) Operation Reclatnaidon permit contains three major parts; (1) the application .fi <br />(2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit'6.5 and Geotechnical SmbilityExhibit, as requin d by the Office, and outtitied in R <br />6,1, 6.2, 63, 6.5, and 1,620)(b), and (3) the application fee- When you submit your application, be sure to include one (1) cp lete. ned <br />and one (1) copy of the completed bm application form, two (2) copies of Exhibits A4, Exhibit L, Addendum 1, <br />appropriate sections of 6.5 (C?eotechnical StabilityExhibit), as required, and a check for the application fee described under (4) below, Exhibits sh <br />be bound or in a 3-ring binder: maps should be folded to 8 12" X 11 " or 8 112" X 14" size. To expedite processing, please provide the infra= <br />in the format and order described in this form <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the apace provided, ALL Information deselrribed below. <br />1 p ? 91 co',Innarrv AAA (nsame to be- used on Dam-111 <br />? <br />1A Type of organization (corporation, partnership, etc.): <br />1.2 I.R.S. Tax ID No. or Social Security Number: <br />2. <br />3. <br />4. <br />5. <br />ct-, •tion 130me fpit give Pr $Re name): <br />?easae fnew orate?: <br />3.1 Change in acreage <br />Total Acreage in Permit Area <br />Ken. <br />43 New Application: <br />Amendment Fee (C.R.S. 34-32.5-125(U))- <br />4.2 Conversion Fie (from 11Qd to 110 IVIQ convossion fM (Rule 1.11-2(2)) <br />_? pczznittcd ac <br />acres <br />acres <br />- 0 4 0 application fee <br />-. S7.1 • .00 . application <br />5.1 incadetraal cornnxocl tics) to be mined: 1.. I 1bslTona 2.. / 159SM& 3• -- ?- 1bs( ?gc? <br />4. ! - IbIMAV11 5- lbslTons/w- <br />pima * com detsl to bepitled: <br />5.2 Anticipated ettd use of primary comnux itie(s) to be mine-d- <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: