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?O"es c, ?,b rr\ <br />RECEIVED STATE of COLORADO <br />DIVISION OF MINERALS AND GEOLOGY Q` t/RECEIVED <br />Department of Natural Resources Division of Reclamation, p <br />• 1313 Sherman St„ Room 215 Mining and Safety Gfv? SEP 112006 COLORADO <br />Denver, Colorado 80203 D I V I S I O N OF <br />Phone: (303) 866.3567 CONSTRUCTION MATERIALS Division of Reelamatio MIN E RALS <br />FAX: (303) 832.8106 v?REGULAR (112) OPERATION Mining and Safety GEOLOGY <br />NATICH-HIN <br />RECLAMATION PERMIT APPLICATION FORM 6CLA <br />TT•SCIINCENC <br />SAFE <br />Bill Owens <br />CI•(ECK ONE: X There is a File Number Already Assiglned to this Operation Governor <br />Russell Go" George <br />Permit # (Please reference the file number currently assigned to this operation) Ex-Alve Direuor <br />New Application (Rule 1.4.5) Amendment Application Rule 1.10 Ronald W. CaRmy <br />( ) Division DLecme <br />__X Conversion Application (Rule 1.11) Natural Resource Truster <br />permit # M 1984 -043 t? (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 form; <br />(2) Exhibits A-S, Addendum 1, any sections of Uhibit 6.5 (Geotechnicai Stability Exhibit. and (3) the application fee. When you submityour <br />application, be sure to include one (1) complete sighed and notarized ORIGINAL and one (1) copy of the completed application foam, two (2) <br />copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee described <br />under Section (4) below. E.altibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2"X 11 " or 812" X 14" size. To <br />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 />.FSt: <br />1. ApPlieant/operator or company name (name to be used on Permit): Pel ino " Inc. L-" <br />• 1.1 Type of organization (corporation, partnership, etc.): corporation <br />2. Operatbn name (pier mine or site name): Jesse Lee ?i r ?4!ar a <br />3. Permitted ae neage (new or existing, sit): 9.6 permitted acres <br />3.1 Change in acreage (+) RECEIVED 6.6 acres <br />3.2 'total acreage in Permit area 16.4 acres <br />4. Fees, Jug 12 2006 <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarry Application Division of Minerals and 13ee103y $2.906,00 9uaM application <br />4A Amendment Fee $I 938_0_0.__ arnendmept fee <br />4.5 Convemion to 112 operation (:set by statute) $2.344.00 conversion fee <br />5. Primary oommoditle(s) to be mined: sand gravel <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/Tonslvr 2. / lbs/1'on r <br />3. / Ibs/Tons/ 4. / lbs/Tons? 5. / lbs/Tonsl? <br />5.2 Anticipated end use of primary commoditie(s) to be minx!: construct ion materials <br />53 Anticipated end use of incidental commoditie(s) to be mined, <br />. Office of Office of Colorado <br />Mined Land Reclamation Active and inactive Mines Geological Survey