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q-oelf-/ <br />STATE OF <br />DIVISION OF RW MAT0K MINING AND SAFETY <br />D40me Nof Nat" Renounces <br />1313 ShemwtSt., Room 213 C O L D iI A D O <br />D e a v e r , C o l o r a d o 0 0 1 0 3 C O N S T R U C T I O N M A T E R I A L S D I V I S I O N (ON <br />Fborre: (303) 866-3567 <br />FAX: !3031632-8106 <br />REGULAR (112) OPERATION MINING <br /> <br />SA &? <br /> RECLAMATION PERMIT APPLICATION FORM SAFETY <br /> ant Riser, Jr. <br /> <br />ECK ONE 0 <br />There is s File Number Already Asdgnred to this Operatbn G rAmm <br />CH Hw6D. Shemm <br />P ' m (Please reference the file bomber curreatTy assigned to this opersdo4wave D:.cnr <br />U/ I New Application (Rule 1.4.5) .oAnaendmeat Application (Role 1.10) DPA" W. +vldon DID <br />MConverdonApplication(Rule L lI) 10e101n'Tn1Ae0 <br />Permit 0 M _ (provide for Amendments and Converalons of existing permits) <br />The applicom for a Constrttetiaa Materials Regular 112 Operation Reclamation Permit eonteuts three mayor parts: (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6-5 (Creotochnieal Stability Fxhabit; and (3) the application fee. When you <br />submit your application, be sure to include one (1)1gmRl= sip and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of fthibits A-S, Addendum 1, appropriate sections of 6.5 (GeoWAWcal Stability Exhibit, and a cbeckf)r <br />the application fee described under Section (4) below. Exhibits should 1= be bound or in a 3-ring binder; maps should be folded to <br />812" X 11" or 81/2" X 14" size. To expedite processing, please provide the information in the forrnnt and order described is finis form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provLded, .L information requested below. <br />1. Annllcant/omerator Qr eomanv name (name to be used on mermmllt): Asphalt Constructors, Inc. <br />1.1 Type of organization (corporation, partner ft, etc.): Corporation <br />2. ODemtion name (nit, mine p, al_ is name): samosa Flt <br />3. IPermlttal acre see (sew or exislime site): 89.38 permitted acres <br />3.1 Charge in acreage (+) acres <br />3.2 Toml acreage in Peammnit area 89.38 acres <br />4. Iff. 4.1 Now Application 52.646.80 application fee <br />4.2 New Quarry Application 5,3342.00 quatN application <br />4.4 Amendment Fee 52«'EX4.00 amp fee <br />4.5 Conversion to 112 operation (set by statute) conversion foe <br />5. ditle(al to be m1pyd Sand <br />5.1 Incidental commoditie(s) to be mined: 1. none _ lbsi l dw& 2. / lbs/fons/vr <br />3. lbs/fonslvr 4. / 1bs(rmslvr 5. / hbs/T'ons/vr <br />5.2 Anticipated end use of primary conuuoditie(s) to be mined: Concrete & asphalt aggregates & earthwork fill operations <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: n/a <br />DEC 212009 <br />o(Rce of aria ffiee of <br />Mired land Reclamation Denver • Grand Junction • Durango Active and Mmac" mkm