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RECEIVED APR 2 $INI <br />STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Departrnent of Hat" Remates <br />1313 Sherman SL, Room 215 <br />Denver, Colorado b0203 COLORADO <br />phone (3 0 3 ) 866.3567 C O N S T R U C T I O N MATERIALS D I V I S I O N o <br />RECLAMATION <br />PAX: 003) 832-8106 REGULAR (112) OPERATION MINING <br />RECLAMATION PERMIT APPLICATION FORM SAFETY <br />am alp ,1? <br />CHECK ONE: There Is a File Number Already Assigned to this Operation ?OV°"0f <br />HWrk o <br />P M ?} ease reference the file number currently assigned to this operatio>t)ecuwe Director <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) R-Wd w CaftW <br />Division DLector <br />Conversion Application (Rule 1:11) A Haaw Resource Thme <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 inchtde 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 (Geotecbmcal Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a Sating binder, maps should be folded to <br />8 1/2" X 11" or 81/2" 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, AI information requested below. •-?- <br />i. Applicantleverator or company name (name to be used on permit): le? Zo CaNc5 / r 4&9w <br />1.1 Type of organization (corporation, partnership, etc.): --S-Q MTCS <br />2. Uhe ration name (pit mine or site name) ~^ 6 s /? <br />3. Per mitted acreage (new or ezistine dte): 9 `'12 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Permit area <br /> <br />acres <br />Az? <br />4. Fees: <br />T <br />- <br />4.1 New Application $2.696.00 application fee <br />4.2 New Quarry Application $3342.00 quarry application <br />4.4 Amendment Fee 9.00 went fee <br />4.5 Conversion to 112 operation (set by <br />st <br />tute) <br />a 00 conversion fee <br />5. Prim ? <br />? <br />' <br />ary commoditie(s) to be mined e) <br />: EL- <br />5.1 Incidental commoditie(s) to be. mined: 1. - AWTon. W 2. / lbs/Tons/vr <br /> 3. / 1bsrTons/vr 4. / lbs/Tomt/w <br />- 5. <br />51 Anticipated affil use of primary commoditie(s) to be mined: r - <br />122k? X g <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />S <br />Office Mined Land RecWnadon 1 Denm • Grdnd IlenCdW • Durango Active Office of <br />and Inactive Mines