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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Departrnent of Natural Resources <br />1313 Shertnan St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 6663567 <br />FAX: (303) 8328106 <br />OF COLORADO <br />J??® Fp <br />s ran9o , ?Q1Q <br />1?n o, Min ? of R cl <br />ng ana Sa ea oh <br />CONSTRUCTION MATERIALS <br />wE m 5 E?> LEMTED IMPACT (110) OPERATION <br />-MNTE? A-L-,5r- RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: 0 There is a File Number Already Assigned to this Operation <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Bill Ritter, Jr. <br />Governor <br />Harris D. Sherman <br />Executive Director <br />Ronald W. Czttany <br />Division Director <br />Natural Resource Trustee <br />Permit # M - - - (Please reference the We umber currently assigned to this operation) <br />? New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />- Conversion Application (Rule 1.11) <br />Permit # M - - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be <br />sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 81/2" X <br />11" 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 described below. <br />1. Applicaut/operator or company name (name to be used on permit): t rrA- f;n <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (pit, mine or site name): <br />LLC <br />Tierra Piedra Gravel Pit <br />3. Permitted acreage (new or existing site): 6.4 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Permit Area 6.4 acres <br />4. Fees: <br />4.1 New Application: $1,258.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(In): 827.00 application fee <br />4.2 Conversion Fee (from 110d to 110 $2,696.00 conversion fee (Rule 1. 11.2(2)) <br />5. Primary commoditie(s) to be mined: gravel sand <br />5.1 Incidental commoditie(s) to be mined. 1. / - lbs? 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br />4. / lbsJTons/vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: road base and fill material <br />Anticipated end use of incidental commoditie(s) to be mined: reclamation, revegetation <br />Office of office of <br />Mined Land Reclamation Denver • Grand Junction • Duraneo Actives and Inanivp Mint