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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St, Room 215 <br />Denver, Colorado 80203 COLORADO <br />Phone: (303) 866.3567 CONSTRUCTION MATERIALS REC I S I O NIO F <br />FAX: (303) 832-8106 REGULAR (112) OPERATION MINING <br />RECLAMATION PERMIT APPLICATION FORM SAFETY <br />y Bill Ritter, Jr. <br />CHECK ONE: 2 There is a File Number Already Assigned to this Operation Governor <br />?? ?' - 00 Harris D. Sherman <br />Pe M -_- - (Please reference the file number currently assigned to this operatiOX)ecutive Director <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Ronald W. Cattany <br />Division Director <br />Conversion Application (Rule 1.11) Natural Resource Trustee <br />Permit # M o O_4Q _- O '( (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 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits 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 folded to <br />8 1/2" X 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 requested below. t <br />1. Applicant/operator or company name (name to be used on permit): 01-Y ("I 1 Zr0 Sr? O (\, e C <br />1.1 Type of organization (corporation, partnership, etc.): - Mn/ K ? Vnr4 A E, l 1. L? ?4 (1, ?eY*z, W1 <br />ore. ? err <br />2. Operation name (pit, mine or site name): Gt, r f 4 Z'O G Y ? q <br />3. Permitted acreage (new or existing site): 1 1 b permitted acres <br />3.1 Change in acreage (+) l acres <br />3.2 Total acreage in Permit area acres <br />4. Fees: <br />4.1 New Application $2,696.00 application fee <br />4.2 New Quarry Application $3,342.00 quarry application <br />4.4 Amendment Fee $2.229.00 amendment fee <br /> Conversion to 112 operation (set by statute) CJ Y`eo„4,1 5.0 a Wt?r ^? $2,696.00 conversion fee ?' <br />5. ` Primary commoditie(s) to be mined: '5 C-11- NcC 5* O A IP-1 <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/vr 2. "X \. CC., lbs/Tons/vr <br /> <br />5.2 3. lbs/Tons/yr/yr 4. lbsfrons/yr 5. <br />V c-4- ? ov - <br />Anticipated end use of primary commoditie(s) to be mined: ?C p???r u c.-?- t ov,- Ibs/Tons/yr <br />-? \ e <br />-- ' cV\ e <br />5.3 ? <br />Anticipated end use of incidental commoditie(s) to be mined: A <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines