2011-04-19_REVISION - M2001056

• Permit No: M2001056
• IBM Index Class Name: Revision
• Doc Date: 4/19/2011
• Doc Name: Completeness Docs.
• From: Elbert County Road and Bridge Department
• To: DRMS
• Type & Sequence: AM1
• Email Name: JLE
• Media Type: D
• Archive: No

STATE OF COLORADO
DIVISION OF RECLAMATION, MINING AND SAFETY
Department of Natural Resources
1313 Sheman St., Room 215 COLORADO
Denver, Colorado 80203 DIY 1 5 I O N O P
Phone (303) 866r3567 RECLAMATION
MINING
FAX: [phone]
SAFETY
CONSTRUCTION MATERIALS Bill Ritter, Jr.
Governor
LIMITED IMPACT (110) OPERATION Barris D. Sherman
RECLAMATION PERMIT APPLICATION FORM Executive Director
Ronald W. Caft"
Division Director
Natural Resource Trustee
CHECK ONE: There is a File Number Aiready Assigned to this Operation
Permit # M (Please reference the umber currently assigned to this operation)
B New Application (Rule 1.4.5) Amendment Application (Rule 1.10)
Conversion Application (Rule ?. 11)
Permit # M (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the
application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required
by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(l)(b); 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-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for
the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 81 /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.
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, ALL information described below.
1. ADplicantlouerator or company name (name to be used on permit): PT
1.1 Type of organization (corporation, partnership, etc.): in 16Ear
2. Operation name (pit mine or site name): REJ:
3. Permitted acreage (new or existing site): S _9 6 permitted acres
3.1 Change in acreage (+) t.940 acres
3.2 Total Acreage in Permit Area q 9D acres
4. Fees:
4.1 New Application: $1.258.00 application fee
Amendment Fee (C.R.S. 34-32.5-125(II)): 8$27.00 application fee
4.2 Conversion Fee (from 110d to 110 2 6$ , 96.00 conversion fee (Rule 1. 11.2(2))
5. Primary commoditie(s) to be mined: C-s A 1
5.1 Incidental commoditie(s) to be mined: 1. / lbs/Tons/vr 2. / lbs/Tons/vr 3. / lbs/Tons/vr
4. / lbs/Tons/vr 5. / lbs/Tons/vr
5.2 Anticipated end use of primary commoditie(s) to be mined: LAO QS
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