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SrATE CJF COLORADO <br />DIVISION OF WaAMATION, MINING AND W M <br />Deimunentof ]Tatars] Resoumes PNCW? <br />1313 Sherman 5L, Roan 215 <br />O <br />Dw4er,e0203 CO L SOION RAD O N <br />Plana (303) 866.3567 JAN '0 3 2011 Dryr RECLAMATION <br />FAX (303) 8324106 Dkow" at f!>wcWWRI&q MINING <br />1?Qrli? ate SAFETY <br />CONSTRUCTION MATERIALS am nw, 1< <br />LE KITED Il"ACT (110) OPERATION Governs <br />Harris o. shennan <br />RECLAMATION PERAW APPLICATION FORM 600Ai«e oheew <br />Ro-W W. Ca" <br />Di don oheaw <br />CI??CIIi OA There Is a File Number Already A '"'? O"'0B T" ° <br />y signed to this Operation <br />Permit # M _ _ (Please reference the currently assigned to this operation) <br />? New Application (Role 1.4.5) Amendment Application (Rule 1.10) <br />_ Conversion Application (Mule 1.11) <br />Permit # _V_- - - (provide for Amendments and Conversion(: of ex=sting permits) <br />The application for a COushuctiou Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A -J, Exhbit-L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as reVired <br />by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(l)(b); and (3) the application fee. Whenyousubnityourapplication, be <br />sure to include one (1) cco lets siMed and notarized ORIGINAL and one (1) copy ofthe completed application form, two (2) copies <br />of Exhibits A -j, Exhibit L, Addendinn 1, and appropriate sections of 6.5 (Geotechnicai Stability Exhibit), as required, and a check for <br />tier application flee desanbed under (4)below . Exhibits should= be bound or in a 3-ring binder; maps shouldbe foldedto 81/2-X <br />11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the fomanat and order described in this form. <br />GENERAL OPERATION INFORMATION <br />1'ype or print clearly, in the space provided, ALL informmtien described below.. <br />1. Apulicantlo»erator or comoauv name (name to be used on aermit): 60174?OQ??''??1L° <br />1.1 Type of organization (corporation, partnership, etc.): County Govemment <br />2. Oiwatien name (uit, mine or site name): 7Y Rana) Pit #1 <br />3. Permitted acttW (new or emdatina site] - 9.9 permitted acres <br />3.1 Change in acreage (+) acres <br />31 TOW Acreage in Permit Area 9.9 acres <br />a-- <br />4.1 New Application: 1 application flee <br />Amendment Fee (C.R.S. 34-32.5-125(In): 5"2 .00 application f= <br />4.2 Conversion Fee (from 110d to 110 V A%.90 conversion fee (Rule 1. 11.2(2)) <br />5. Primary c2mmodide(a) to be mined Gravel Clay _ Sand <br />5.1 Incidental commoditie(s) to be mined: 1. / Ibs/I ons/vt 2. ! ]bs/Tons/ 3. 1 lbslTo <br />4. / bs/Tonslvr 5. / Ihmsf[ons/tir <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Road construction <br />Anticipated end use of incidental commoditie(s) to be mined. Landseapinct materialDO <br />Office of Office of <br />Mined Land Redamadon Denver - Grand ]unction - Duranfio Alive and loactive Mines