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C-1 <br />s <br />DIVISION OF MINERALS AND GEOLOGY <br />Dvgblrlment of Maurat Rewources <br />I i I 1 Sherman St., Realm 21 i <br />OtMV, Caluracto 1W203 <br />Phom: (11)316h6.35b7 <br />FAX: (3031 S12-1111)6 <br />?unig?a?m <br />)F COLORADO <br />RECEI VEp <br />JAN 0 8 2001 <br />Division of Miasma and %olosy <br />?? <br />Dlvrslo ?.Wlo r, <br />MINERALS, <br />GEOLOGY; <br />RECLAMATION <br />MINING•SAFITY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM a,I1 Owrns <br />Cewe.nsr <br />COME WilO1l+ <br />Executive 04rerler <br />CHECK ONE New Application (Rule 1.4.5) Amesdsreat A kation Rule 1.10MM?h'°i a. t°re <br />>tP ( OmHOn arecln <br />C nvversim Application (Rule 1.11) <br />r <br />Permit # M -?W (provide for Awndmnts and Conversions of existing permits) <br />The application for a Cousnetion Materials Rejular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exitibics A-S. Addendum 1, any sections of ExhWt 6.5 (Geotechnicai Stability Exhibit; and (3) the alppticattiort fee. When you submit your <br />application, be sure to include one (1) CI111210 si W and notarized IVORY ORIGINAL aid four (4) copies of the completed j= <br />application form. five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit. and a check for <br />the appReation fee described under Section (4) below. Exhibits should Na be bound or in a 3-ring binder; maps should be folded to <br />81/2' 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 elea ft in the space provided. "L information rega tined below. <br />1. omptimerator or eamnanv tame (same to be used on perm: Four &a-mss r,, Wbra , <br />1.1 Type of organization (corpomtioa, partnership. etc.): l srncied L js6l;z ii 6=np a <br />1.2 I.R.S. Tax I.D. No. or Social Security Number. %- <br />2. g=tioa_name (nit. cline or site name): LINE CAMP PIT <br />3. EMUW semn (aew or esislift petrified acres <br />3.1 Chwo in acreage (+) acres <br />31 Total acreage in Permit area acres <br />4. W- <br />4.1 New Application S 1.875.00 application fee <br />4.2 New Quarry Application 53.325.00 quarry application <br />43 Milling Application (Non-DMO) Saj 00.00 milling application <br />4.4 Amendment Fee S1.550_00 amendment fee <br />4.5 Catversion to 112 operation (set by salute) 51.875.00 conversion fee <br />5. erlMrY Mmadidds) to be mined; S X <br />5.1 Incidental commoditie(s) to be mined: 1. lbslfoes/vr 2. t Iblaonslvr <br />3. l Ihlt'onssm 4. I lbs)Tonslvr 5. L Ibsrrans/vr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: CDOStri)c..t',gQ MQQ !tj& <br />53 Anticipated end use of incidental commoditie(s) to be mined: