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STATE oF coLoRAnn <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 d=L ,` <br />Denver, Colorado 80203 C O L O R A D O <br />Phone: (303) 866-3567 D I V I S I ON OF <br />FAX: (303) 832-8106 CONSTRUCTION MATERIALS RECLAMATION <br />MINING <br />REGULAR (112) OPERATION -&- <br />RECLAMATION PERMIT APPLICATION FORM SAFETY <br />Bill Ritter, Jr. <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation Harris D. Sherman <br />Permit # M - Executive Director <br />-Q (Please reference the file number currently assigned to this operati%ald W. cattany <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Division Director <br />°•,'Conversion Application (Rule 1.11) Natural Resource Trustee <br />Permit # M - - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 1/2" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />Applicant/operator or company name (name to be used on permit): <br />1.1 <br />Type of organization (corporation, partnership, etc.): <br />2. Operation name (pit, mine or site name): <br />Permitted acreage (new or existing site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />0- <br />4.1 New Application $2,696.00_ application fee <br />4.2 New Quarry Application _ $3,342:66 quarry application <br />4.4 Amendment Fee $2,229.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute)i/ $2,696.00 conversion fee <br />5. Primary commoditie(s) to be mined: -'5 A, V\. ?+ DA e- <br />5.1 Incidental commoditie(s) to be mined: 1. CC- lbs/Tons/yr 2. V, 0 y'\-Cr-- Ibs/Tons/vr <br />3. NO/ k4U lbs/Tons/yr 4. V\ ? Ibs/Tons/yr 5. VVO N (-,Ibs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: N r A- i :c)yl- <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: ' V <br />Office of Office of <br />Mined Land Reclamation Denver • Grand )unction • Durango Active and Inactive Mines <br />7 permitted acres <br />acres <br />acres