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DIVISION OF RECLAMATION, MINING AND SAFETY <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 />rn -aoN\ - o`er <br />CHECK ONE: <br />The application for a Limited Impact (110d) Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -J, Exhibit L, Exhibit T, the Geotechnical Stability Exhibit, the Emergency Response Plan, and Addendum 1, as required by <br />the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.4.20 6.5, 8, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure <br />to include one (1) signed and notarized Original and one (1) copy of the application form, two (2) copies of Exhibits A -J, Exhibit L, Exhibit T, the <br />Geotechnical Stability Exhibit (Rule 6.5), the Emergency Response Plan (Rule 8), and Addendum 1 (Rule I.6.2(1)(b)), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in 3 -ring binders; maps should be folded to 8 2" X 11" or 8 2" X <br />14" size. To expedite processing, please provide the information in the format and order described in this form. <br />1. Applicant /operator or company name (name to <br /> <br /> <br />2. Operation name (pit, mine or site name): PRINCE ALBERT MINE <br />3. Permitted acreage (new or existing site): 2.04 NOI permitted acres <br />3.1 Change in acreage ( +) 6.254 acres <br />Total Acreage in Permit Area 8 acres <br />4. Fees: (Rule 1.5) <br />4.1 New Application $2,875.00 application fee <br />4.2 Amendment Fee (operations existing as of 06/30/94) $1,725.00 application fee <br />4.3 Amendment Fee (operations permitted from 07/01/94) $2,300.00 application fee <br />4.4 After July 1, 1995, to convert a 110(1), 110(2) or a 110 to a 110(d), a new application form for a 110d must be submitted, along <br />with an application fee of $2,875.00 (Rule 1.11.2(2)). <br />5. Primary commodities to be mined: Uranium and Vanadium <br />6. Type of mining operation: 1 Surface 1 ✓ Underground <br />Office of <br />Mined Land Reclamation <br />New Application (Rule 1.4) <br />Conversion Application (Rule 1.11) <br />DESIGNATED MINING <br />LIMITED IMPACT (110d) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />GENERAL OPERATION INFORMATION <br />STATE OF COLORADO <br />Amendment Application (Rule 1.8 or 1.10) <br />Permit # M- (provide for Amendments and Conversions of existing permits) <br />Type or print clearly, in the space provided, all information described below. <br />In -situ <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />Bill Ritter, Jr. <br />Governor <br />Harris D. Sherman <br />Executive Director <br />Ronald W. Cattany <br />Division Director <br />Natural Resource Trustee <br />Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />