2011-03-30_REVISION - M1978210 (3)

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STAT F COLORADO DIVISION OF RECLAMATION, MINING AND SAFETY Department of Natural Resources 1313 Sherman St., Room 215 Denver, Colorado 80203 COLORADO CONSTRUCTION MATERIALS Phone (303) 86635567 67 N RECLAMATION FAX: (303) 832-8106 REGULAR (112) OPERATION MINING RECLAMATION PERMIT APPLICATION FORM SAFETY Bill Ritter, Jr. CHECK ONE: ?? There is a File Number Already Assigned to this Operation Governor 1,978 210 112c Harris D. Sherman P M - (Please reference the file number currently assigned to this operatiox)QUaive Director New Application (Rule 1.4.5)? Amendment Application (Rule 1.10) Ronald W. any Division Dimctor Conversion Application (Rule 1.11) Natural Resource Trustee Permit # M -1978 _ 210 (provide for Amendments and Conversions of existing permits) The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application fort; (2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 112" 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. GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, ALL information requested below. 1. Agpticantloperator or company name (name to be used on permit): Weld County Public Works 1.1 Type of organization (corporation, partnership, etc.): County government 2. Op eration name (nit, mine or site name): Geisert Pit 3. Permitted acreage (new or existing site): permitted acres 3.1 Change in acreage (+) RECEIVED None acres 3.2 Total acreage in Permit area acres MAR 30 2011 4. Dee s: 4.1 New Application ion of Reclamation, i 2 696.(10 application fee 4.2 New Quarry Application s Div Mining & Safety 342 00 quarry app application 4.4 Amendment Fee $2,229.00 amendment fee 4.5 Conversion to 112 operation (set by statute) $23696.00 conversion fee 5. Primary commoditie(s) to be mined: gravel sand 5.1 Incidental commoditic(s) to be mined: 1. - ibs/Tons/yr 2. 1 lbs/Tons/yr 3. 1 lbsrlbns/vr 4. 1 lbstTons/vr 5. 1 lbs/Tonslvx 5.2 Anticipated end use of primary commoditie(s) to be mined: County road maintenance 5.3 Anticipated end use of incidental commoditie(s) to be mined: Office of Office of Mined Land Reclamation Denver • Grand junction . Durango Active and Inactive Mines