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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFEFT <br />DeiwWw a of Natural Resources <br />1313 Sherman SL, Roam 215 <br />Dearer Colorado 80203 C O L O RA D O <br />IrvrsroN oe <br />phone: t303) 866a%7 RECLAMATION <br />FA%: OW) 832.8106 MINING <br />SAFETY <br />CONSTRUCTION MATERIALS BID RAW, Jr. <br />LIMITED EWPACT (110) OPERATION Governor <br />Hwu m shenean <br />RECLAMATION PERbIIT APPLICATION FORM 6mud a okeow <br />RwwW W. CdWW <br />Divislan Director <br />CHECK. OArE: There Is a File Number Already Assigned to this Operation Nand ROOM* Thwee <br />Permit # M - - (Please reference the CUn= y assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Applbatum (Rule 1.10) <br />_,_ Conversion Application (Rule 1.11) <br />permit # M (provide for Amendments and Converdon s of mstmg permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (I) the <br />application form; (2) Exhibits A -J, Exhbit-L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as rege:ired <br />by the Office, and outlined inRules 6.1,6.2,6-3,6.5, and 1.6.2(l)(b); and (3) the application fee. When you submityour application, be <br />sane to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application; form, two (2) copies <br />of txhibits r+ I, 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 Exlnbits should=be bound or in a 3-ring binder; maps shouldbe folded to 81/2"X <br />11" or 81/2" X 14" size. To expedite processing, please provide the information in the foimat and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print dearly, in the space provided, ALL Information dewrIbed below. <br />'S? drlL° ,?ls? <br />1. Apj1& at/oner*Aoor or compauv mane (name to be used on Rq!30): w?1 s? 1129??/1 Cevnzce -O' Q 01 <br />1.1 Type of oigaftation (corporation, part ship, etc.): County Govemment <br />2. Operation name (pit, mine or site name): 7Y Ranch Pit #1 <br />3. Permitbed acrea¢s (new or enliLdog site:. 9'9 permitted acres <br />3.1 Change in acreage (+) acres <br />32 Total Acreage in Permit Area 9.9 acres <br />4. Fees: <br />4.1 New Application: 1 .00 application fee <br />Amendment Fee (CRS. 3432.5-125(11)): SW A application fee <br />4.2 Comrc-sion Fee (from 1104 to 110 $2.696.00 conversion fee (Rule 1.112(2)) <br />5. Prlmarv commodige(s) to be mined: Gravel Gay Sand <br />5.1 Incidental commoditie(s) to be rained: 1- / 1i>_v/ibndw 2. ! lbslTons/vr 3. / 1bslTon4hz <br />4. / HmMorns/vr 5. / <br />52 Anticipated end use of primary c o nmoditie(s) to be mined: Road construction <br />Anticipated end use of incidental coummoditie(s) to be mined Landscapina materialDo <br />office of Office of <br />WnW Land Redanutio r Deswer • Grandlunaim 9 Durango Active and kiacti" Mines