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STATE OF COLORADO <br />DIVISION Of RECIAMATION,'MINiNGAND 5A#L1Y <br />Departnmitof Natural Resouram <br />1313 Sb WMD $t W01n 215 <br />Diner, Colorado 86203 <br />Phase: (303) 0664567 <br />FAX: (303) 832-5106 <br />LIMIT D AMPACT (110) OPERATION <br />RF(?r.e. tr a??rrON.Pu RMff-APMACA.TION.FORM. <br />CHECK ONE: Tk; ere is a File Number Already Assigned to this Operation <br />i'ermiif # ??+i iq7?, ? (Please I+efierenoe the a ===fly assigned to this operation) <br />New Application {Rule 1.4.5) AmApplication (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />permit # M ---- - (provide for Amendments and Conventions of existing, permits). <br />The application fora Construction Materials Limited hnpact.(110) Operation Reclamation Permit contains three majorparts: (1). the <br />application farm; (2) Exhibits A-J, Fxlubit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Erb bit, as required <br />by tine Office,-and outlined in Rules 6.1,.6.2, 6.3, 6.5, and 1.6.2(l(band (1)the application fee. Menyouu submityoura pplicamion, be <br />sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A-1, Exhibit I,,. Addendimn 1, and appropriate sections of 6.5 (Geotechnic al Stability Exhibit),. as required,, and a-check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring bindw, maps should be folded to 8112" X <br />11" or S 1/2" X 14" size. To expedite proces*g, please provide the information in the format and order described in this fDrm. <br />GENML4L OPERATION INFORMATION <br />Type or print dearly, In the space provided, ALL information described below. <br />1. Apnlieant/operator gr ao>onnanv name (name to be used one Hermit): ? r1( ?'O( f` ( ?F' / // ] <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. OysKafion name (nit mine or site name): - - C 010rQ dQ JC06LP- CCO /0 C. <br />3. Permitted aereaae (nerv or exx_ _'stin_ _„_ esitel: permitted acres <br />3.1 Change in acreage (+)Acres <br />3.2 Total Acreage in Permit Area ?. 7 _ acres <br />4. Fees: <br />4.1 New Application: $1,258.00 application fee <br />Amendment Fee (C.ILS. 34-32.5-125(Ll)): 5827.00 applicaiaa feu <br />4.2 Conversion Fee (from 110d to 110 $169 6.x8 conversion fee (Rule 1. 11.2(2)) <br />incai- }1"t <br />5. Pnmarv comioaodil3e(¢1 to be <br />5.1 Incidental commoditie(s) to be rained: L_ / Ibs/Tons/vr 2_ 1 Ibs/Tor?fvr 3. / lb.?lTons/vr <br />4. _ 1 lbs/TonsFvr 5. 1 lbs/T <br />onslvr <br />5.2 Anticipated end use of primary commoditie(s) to be Honed: 9tz'N?. ?-"(` <br />Anticipated end use of incidental commoditie(s) to be ruined: ?0?j V E <br />CONSTRUCTION MATERULS <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />%1 VOW, Jr. <br />Govemar <br />Norris D. Shun <br />Euecative DktCkW <br />X*mm W. C?Mfty <br />Division Director <br />NMmal RMOUrm-FAi me <br />Office of <br />Mined Land Declamation <br />Denm o Grams Junction Durango <br />COLM of <br />Active and Inactive Mines <br />Z-d ZgNL990L6 ael}n8 esi? d6-V: L L L L0 Gaj <br />i