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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 COLORADO <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS D [VISION o e <br />RECLAMATION <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 REGULAR (112) OPERATION MINING <br />RECLAMATION PERMIT APPLICATION FORM SAFETY <br /> Bill Ritter, Jr. <br /> <br />CHECK ONE: 29 There is a File Number Already Assigned to this Operation Governor <br />y Harris D. Sherman <br />Pe> M -19 -M -18 T (Please reference the file number currently assigned to this operation)ecutive Director <br />New Application (Rule 1.4.5) 17 Amendment Application (Rule 1.10) Ronald W. Cattany <br />Di <br /> <br />Conversion Application (Rule 1.11) rector <br />Division <br />Natural Resource Trustee <br />Permit it M - I q - M I ti? (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 />1. Applicant/operator or company name (name to be used on peer/rmit): L 0 0.A ? o-vA -A <br />1.1 Type of organization (corporation, partnership, etc.): C-' . A ' Gas <br />2. Operation name (pit, mine or site name): , `-" ` `? <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage(-,) <br />3.2 Total acreage in Permit area <br />Ll <br />Sb• 6g <br />permitted acres <br />acres 31 ' 2-2 <br />acres <br />4. Fees: <br />4.1 <br />New Application <br />$2,696.00 <br />application fee <br />4.2 New Quarry Application $3,342.00 quarry application <br />4.4 Amendment Fee $2,229.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2,696.00 conversion fee <br /> :50?4 & COWQA <br />d <br />b <br />i <br />i <br />i <br />5. Prim ne <br />: <br />e m <br />e(s) to <br />t <br />ary commod <br />5.1 Incidental commoditie(s) to be mined: 1. ^L- ibs/Tonslvr 2. ! lbs/Tons/yr <br /> 3. / Ibs/Tons/vr 4. / lbs/Tons/vr Q 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: Ao v\. e <br />Office of Office of <br />Mined Land Reclamation Denver • Grand junction • Durango Active and Inactive Mines