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<br /> STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Nat aW RewwDes <br />1313 Sherman St., Room 215 COLORADO <br />Dwiff, CoiOWo 80203 CONSTRUCTION MATERIALS DIVISION OF <br />RECLAMATION <br />Phone: (303) 866-3567 <br />FAX: poi) 832.8106 REGULAR (112) OPERATION MINING <br /> RECLAMATION PERMIT APPLICATION FORM y <br /> M - 0 <br />? 8iit Ritter, lr. <br />Assigned to this Operation <br />berAlread <br />N cam <br />y <br />pm <br />CHECK ONE. _ Tisrlav ts D. She~ 17-2005-006 p (Please reference the file number currently assigned to this operation)ecuttve Di edDr <br />New Application (Bute 1.4.5) Amendment Application (Rule 1.10) ?Wm? <br />Conversion Application (Rule 1:11) Nat uat Resou" Tru we <br />Permit # M 2 0 0 5 _ 0 0 6 - (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 (Geotwhmcal Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to inchtde one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Extubits 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 ford to <br />8 1/2" X 11" or 81/2" 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, ILL information requested below. <br />Moffat Countyy Bog.rd of <br />1. Amilicant/operator or company name (name to he used on permit): County C om111iS s 1 oners <br />1.1 Type of organization (corporation, partnership, eft.): Local Government <br />2. Operation name (nit, winter site name): P o w de rw as h Pit No. 66 <br />3. Permitted a e (new or eAsIng 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 operation (set by statute) <br />30.85 permitted acres <br />+ 0.18 acres <br />31-03 acres <br />$2.696,00_ application fee <br />$3.342.00 quarry application <br />XXX $2.229.00 amendment fee <br />$2.6-%.00 conversion fee <br />5 Primary commoditie(s) to be mined: Gravel Sand Clay _ __ <br />5.1 Incidental commoditie(s) to be mined: 1. N/A lbslTons/vr 2. / 1bslTons/vr <br />3. / Ibs/Tondvr 4. / go -W-/ 'a 5. lbsffoWn <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road Construction Materials <br />5.3 Anticipated end use of incidental commoditie(S) to be mined: N/A <br />DEC ® 3 2009 <br />GRAND JUNG kji i riL:LL) OFFICE <br />Office of office of <br />O <br />Mined LW RalWlliflATION MINING SAfi_nr Dower " talon Acfi" and Iroctive Mines