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DIVISION OF RECLAMATION, MINING <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />M - ,a a STATE OF COLORADO <br />REcovra <br />JUL 2 0 2911 <br />Divi$ion of Kaclamation, <br />Mining end SAY <br />Operation name (pit, mine or site name): <br />Permitted acreage: <br />New Application: <br />Primary commoditie(s) to be mined: <br />Mined Land Reclamation <br />AND SAFETY <br />RECEIVED <br />JUL 1 4 2011 <br />Durango Field Office <br />Division of Reclamation <br />Mining and Safp t y <br />' <br />CONSTRUCTION MATERIALS <br />SPECIAL (111) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />The application for a Construction Materials Special 111 Operation Reclamation Permit contains four major parts: (1) the application form; <br />(2) Exhibits A -L, Addendum 1, and any sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); (3) the application fee; (4) the Performance Warranty and if required a Financial Warranty. When <br />you submit your application, be sure to include one (1) completed, signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as <br />required, a check for the application fee described under (4) below, and the frilly executed Performance Warranty and Financial Warranty, if <br />required. Exhibits should NOT be bound or in 3 -ring binders; maps should be folded to 8 2" X 11" or 8 2" X 14" size. To expedite <br />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 described below <br />1. Applicant /operator or compan name (name to be used on the permit): <br />< I / ; 1.5L; c <br />1.1 Type of organization (corporation, partnership, etc.): ZL C <br />f s 7 Uo /F (' rX <br />/ 40 / <br />Name of owner to the surface of affected land: <br />Name of owner to the subsurface rights of affected land: <br />Type of mining operation: I L' I Surface n Underground <br />In -situ <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />SAFETY <br />BiII Ritter, Jr. <br />Governor <br />Harris D. Sherman <br />Executive Director <br />Ronald W. Cattany <br />Division Director <br />Natural Resource Trustee <br />`r Permitted Acres <br />$898.00 Application Fee <br />Location information: The center of the area where the majority of mining will occur: <br />CO /' l i A)gle_it, / <br />PRINCIPAL MERIDIAN (check one): 6th (Colorado) 1 ' 1pth (New Mexico) D Ute <br />SECTION (write number): S i g <br />TOWNSHIP (write number and check direction): T ..:1 7, r' North South <br />RANGE (write number and check direction): R . O �� East West <br />QUARTER SECTION (check one): NE NW SE SW <br />QUARTER/QUARTER SECTION (check one): I NE 11 NW SE SW <br />GENERAL DESCRIPTION: (the number of miles and direction from the nearest town and the approximate elevation): <br />L: A .irn - �t,4 - t e, f Sp 4 f k o ie k GO 1C) )( AL &9 c4 /An <br />Office of Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />