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STATE OF COLORADO <br />DIVISION Of RMU MATION,MINIPlGAND SAfL1Y <br />Depamrwnt of Natmal Resourcm <br />i m3 Sherrrwn St, Rmm 215 <br />Deaver, CAtaeado 0183 <br />Phone: (3013) 8WI567 <br />PAX-- (303) 9324106 <br />COLORADO <br />DIVISION OF <br />CONSTRUCTION MATERIALS Ylt l.l? <br />LBAErKD EMPACT (110) OPERATION Gavema <br />Baffin a she <br />RECLA1 LAMON.PFAUM-APP'LrICATIONTORM. EWC0 "Ohecnr <br />I Ronatd W. Cmany <br />oivision 01psaw <br />ROMOUift <br />r <br />CHECK ONE. Tk; em is a Fffe Number Already Aarsigned to ibis Operation ram <br />Permif # M (Please reference fine assigned to this operation) <br />NewApphcat5ion (Rule 1.45) trA= Application (Rule 1.10) <br />Cojrversioa Application (Rule 1.11) <br />Permit # M (lmovid,e for Amendments and Conventions of exit, permits). <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major.parts: (1). the <br />application form; (2) Exhibits A-J, Fahtbit L, Addendum 1, any sections of Exhibit 6.5 and. Geotechnical Stability Exhibit, as required <br />bythe Office, andoutlinedin Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1 b); and applicationfee. Whenyonsubm#tyourag_plication,be <br />sure to include one (1) coxnalete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Fxbibits A-r, Exhibit L, Addendun 1,. and appropriate sections of 6.5 (Geotechmcal Stability Fxbibitl as requ:it4 and a.check for <br />t h e a p p l i c a t i o n f e e descnbed u n d e r ( 4 ) below. E x h i b i t s s h o u l d Q be bound o r in a 3 - r i n g b i n d e r ; m a p s s h o u l d be f o l d e d t o g 112" <br /> X <br />11" or 81/2" X 14" size. To expedite processift, please provide the infartnation in the fomat and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL infermatlon described below. <br />1. ARROcant/onerator or aompM agate Game to be used on permit): (- lQ k-oc1't (a CP u ? I!? C . <br />1.1 Type of organizatiau (corporation, partnership, etc.): <br />2. nMg (pit, mine or site name : (Id lvra do PE-a 0 f t l c . <br />3. Penwitled acreage ftI or esil ft site): permitted acres <br />3.1 Change in acreage H q acres <br />32 Total Acreage in Permit Area ?. _ acres <br />4. Fees. <br />4.1 New Application: S 5$.00 applicafion fee <br />Amendment Fee (C.,.. 34-32.5-125(11)): ?5827.00pplic-*on fea <br />4.2 Conversion. Fee (from 110d to 110 $U96.00 conversion fee (Rule 1. 11.2(2)) <br />5. Primary mmuaod!"s) to be rained: <br />5.1 Incidental commoditie(s) to be trained: 1. I lbsffons/yr 2. 1 IbslTotrs/vr 3. 1 lbslRons/yc. <br />4. 1 wrons/yr 5. 1 lbs/TonsFYr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: 5Ta?J? ?P"u'r? <br />Anticipated end use of incidental commoditie(s) to be mined: 0?j ?- <br />office of <br />Mined Land Reclamation <br />Z-d <br />Z906L990L6 <br />Denver • Grand Junction • Dusaegp <br />Calm of <br />Active and inactive Mines <br />ael}n8 esil d6t,: L L L L0 qej