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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />' <br />Department of Natural Resources ? <br />1313 Sherman St, Room 215 COLORADO <br />Denver, Colorado 80203 D I V I S I O N Of <br />Phone: (303) 866-3567 RECLAMATION <br />FAX: (303) 832-8106 MINING <br />- <br /> SAFETY <br />CONSTRUCTION MATERIALS Bill RHW, Jr. <br />L1QWMD IMPACT (110) OPERATION Governor <br /> Harris D. Sherman <br />RECLAMATION PERMIT APPLICATION FORM Exeaalve Director <br /> Ronald W. Cauany <br /> Division Director <br />CHECK ONE: E] There is a File Number Already Assigned to this Operation Natural Resource Tnraee <br />Permit M (Please reference the filtaumber currently assigned ti) this operation) <br />New Application (Role I A.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 Geotechnicai 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 sieved 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 (Geotechnicai 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. Applicant/o erator or company name (name to be used on permit): Q M S / ?Z r°?5 ?° <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (pit mine or site namel: s CA ? QVe f) C G- C" ?-- <br />3. Permitted acreaee (new or eidstine site): s permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total Acreage in Permit Area acres <br />4. Fees: <br />4.1 New Application: $1.258.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(U)): $827.00 application fee <br />4.2 Conversion Fee (from 110d to 110 $2.6%.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: K - <br />5.1 Incidental commoditie(s) lobe mined: 1. / lbsGons/vr 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br />4. / lbsrTons/vr 5. / lbs/T <br />5.2 Anticipated end use of primary commoditie(s) to be mined: ?r <br />Anticipated end use of incidental commoditie(s) to be mined: <br />Office Of Office Of <br />Mined WW Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />CEWFP <br />APR 2 9 2010 <br />MMO Ot K8C13tT?811A11, <br />OM and 3aletY