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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) 8324106 <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />PRINCIPAL MERIDIAN (check one): <br />SECTION (write number): <br />TOWNSHIP (write number and check direction): <br />RANGE (write number and check direction): <br />QUARTER SECTION (check one): <br />QUARTER/QUARTER SECTION (check one): <br />RECEIVED <br />JUL 14 2011 <br />Durango Field Office <br />Division of Reclamation, <br />Mining and <br />CONSTRUCTION MAT <br />SPECIAL (111) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />In -situ <br />• <br />Location information: The center of the area where the majority of mining will occur: <br />CO <br />STATE OF COLORADO <br />a0// -d3f <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 fully executed Performance Warranty and Financial Warranty, if <br />required. Exhibits should Tel ,1 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. Aunlicant/onerator or comDan name (name to be used on the permit); <br />�rl f g Pfl 15.e 3 4.4c <br />1.1 Type of organization (corporation, partnership, etc.): 4.4. C <br />Operation name (nit, mine or site name); 'R 5 f k / C <br />permitted acreage: <br />New Aoolictttlon: <br />primary commodities) to be mined: /1 / t ?TO in <br />JIame of owner to the surface of affected land: 4e <br />Name of owner to the subsurface rie)tts of affected land: <br />'rye of minim: oneration: TSurface El Underground <br />6th (Colorado) <br />S <br />T a'el.0 <br />R <br />Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango <br />North <br />East <br />10th (New Mexico) <br />© South <br />West <br />NW <br />NW <br />SE <br />SE <br />® Ute <br />COLORADO <br />DI VISION O <br />RE CI.AMATION P <br />MINING <br />SAFtTY <br />801 Ritter, Jr. <br />Gomm <br />Harris D. Sherman <br />Executive Director <br />Ronald W. Caaany <br />Division Director <br />Natural Resource Trustee <br />1, 9 Permitted Acres <br />S$98A0 Application Fee <br />SW <br />SW <br />GENERAL DESCRIPTION: (the number of miles an • rection from the nearest town and approximate elevation): <br />L t S", ;` e t k Ce d 1e 00 c4 4045 ' <br />Office of <br />Active and Inactive Mines <br />