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STATE OF COLORADO <br />DIVISION OF290AMATION, MINING RECEIVED <br />Dgaannwo of r &WW Rescufm <br />1313 Skrormsn R Room 215 C O L D AA D O <br />DiYi3lOM OF <br />Doom, Calor"o UM JAN 0 3 2011 DEC 2 2 2010 RECLAMATION <br />Hww (303) 0663567 MINING <br />FAX: (303) 006106 OW&A ? GMWAW.. i !Q% rs ? ()FF((,F' && <br />WIN t4 ed w DiLRs.em a SAPBTY <br />/ ?tJIL'D?+er x6?"?-;? '? SA'FE?if <br />pA_DLO Q -0$0 V CONSMucnoN MATERIALS ? stn Ruv,1? <br />LIIMITED IMPACT (310) OPERATION / t sank o. sh.nnm <br />DbKW <br />RECLAMATION PERMIT APPLICATION BORM V "-Ca" <br />asrNy <br />oawwe pi„e,r <br />QUOUM U- These 1sa Me Namba Atmdy AWVmd to this Operation <br />Q$ (please i?eratce the cvcieNlY asaaigoed to this operation) <br />Permit#. ? ?0. ?Q _ : ? a?1.10) <br />Na. Application (Kure 1.4.5) <br />Comverslon Application (Rule 1.11) <br />Permit # M (provide for Amy and Convenkns of eacisting permits) <br />The $pplicatian far a Coo:aruc6on Materials Impact (110) Operation Reclamation Permit eontaku three mayor pattx (1) the <br />gpplicad=f mmg (2) ExbVift A J,13rb%k L, Addendum 1, anyvactiMS and (3°f appj ??yaStability Ekbi ltap, reion,ed <br />by the Office, andoathaedinRulea 6.1.62,63,6.5, and 1.6.2(lxb} <br />sraet0includeow (1) andone(1) copyofthe completed applicati inform. two (2) Capin <br />of Ekbibits A -J, Embibit L, Addendum 1, and appropriate se ctiow of 6.5 (tseoteehnicai stability Exbibit), as required, ad a check for <br />ftgp1=t1onfeed=rI1jedundw(4)below F,xbzntaswWgffbeboundarina3-ftbin wmap dwuldbefoldedto8l/YX <br />11" or 81/2" X 14" aiw. To expedite procmiag, please provide the iof mubon is the format and order doecn'bad in dds form <br />QENEM OPERATION 5 FORMATPON <br />'ripe or print gleam, is the space provided, ALL Informstim dewsmed below. <br />-.o- -ttir or ny name (name to be ased an"Mm L- es i L,0.tl?e. L L 6-:" <br />. 1, ?:. <br />1.1 Typeeforpniudm(oorpearation,pwmershiPetc.): LimitedUabifdyCompany <br />I.ASt Cause Pond <br />2. Ooeratloea name (alt. amine or, die aWl: <br />9.9 pa=aed acres P-amftd 3.1 Change in asa=P (+) 9.9 acme 32 Total Acreage in Permit Area acm <br />4. F• application fee <br />4.1 NewApplicatioW applicationfoe <br />Amendment Fee (CJLS. 34-32.5-125(il)) <br />4.2 COUversion Fee (from i 10d to 110 PAI&OD oooveiOn fee Mlle 1.112(2)) <br />Silt mated *OM water run-off <br />Mina <br />5. <br />5.1 lncideWdcommoditie(s)tobemined: 1. ! ibsrroashT 2. / IbslTo»aaCvs 3. / lbs/Tasudvr <br />4. / lbe/T'onslr? 5. / me/Pons/vr <br />52 Antickwoed end use of primary comamoditic(s) to be mined: Construcdlon maiterial / fifl dirt <br />Anticipated and use ofixiddautal commoditie(s) to be mined: rda <br />Offln of <br />ofike of Deserver " Grand lea ' DessW Active and reactive MhMf <br />Maned herd RaJwm ioer?