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AM 2. <br />STATE OF COLOKADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 C O L D RA D O <br />Denver, Coior o 80203 DIVISION OF <br />Phone: (303) 866-3567'x{ D REM ILA NTG N <br />FAX: (303) 832.8106 _ IN <br />SrP 2 9 2090 SAFETY <br />CONSTRUCTION MATER ion of Re--l inaticn, sill River, Jr. <br />? and 5t+f Governor <br />LIMITED IMPACT (110) OPERA Harris D. Sherman <br />RECLAMATION PERMIT APPLICATION FORM Executive Director <br />Ronald W. Cattany <br />Division Director <br />Natural Resource Trustee <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M -1989 - 023 (Please reference the 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 - 989 023 (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: (I) the <br />application forum; (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) corn lete 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 8 1/2 X <br />11" or 8 I/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 />I. Anplicant/oyerator or company name (name to he used on permit): - - <br />a <br />1.1 Type of organization (corporation, partnership, etc.): Individual <br />2. Operation name it, mine or site name): <br />3. Permitted acres e? lnen or existing sitej: <br />3.1 Change in acreage (+) <br />3.2 Total Acreage in Permit Area <br />Caliche School Pit <br />5.4 permitted acres <br />4.1 _ acres <br />9.5 acres <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34-32.5-125(In): <br />4.2 Conversion Fee (from 110d to 110 2 6S 96.00 conversion fee (Rule 1.11.2(2)) <br />8.00 application fey <br />!15 <br />2 <br />827.00 application fee <br />5. Primary commoditie(s) to be mined: r vel Clay_ Sand_ <br />5.1 Incidental commoditic(s) to be mined: 1. / lbs/Tons/yrr 2. / lbs/Tons/vr 3. ! lbs/Tons/vr <br />4. / lbs/Tons/yr 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road construction materials <br />Anticipated end use of incidental commoditie(s) to be mined: N/A <br />office of office of <br />mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines