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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY RECEIVED <br />Department of Natural Resources <br />Denver, Colorado 80203 AUG 13 2002 / <br />1313 Sherman St., Room 215 ✓ DIVISION O F <br />Phone:1303) 866 -3567 MINERALS' <br />FAX: (303) 832 -8106 Division of Minerals and Geology <br />CONS GEOLOGY <br />FILE COPY <br />CONSTRUCTION MATERIALS R E C L A M A T I O N <br />MINING - SAFETY 1 <br />LIMITED IMPACT (110) OPERATION <br />FOR SCANNING ECLAMATION PERMIT APPLICATION FORM Govenr <br />Owens <br />Greg E. Walther <br />/ Executive Director i( At -.200,2 -cos-7 Michael 8. Long <br />CHECK ONE: New Application (Rule 1.4) Conversion Application (Rule ?lvrj°n Direct« <br />Amendment Application (C.R.S. 34- 32.5 -110) <br />Permit # ,- (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A -I, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules <br />6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure to include one (1) gomnlete signed and <br />notarized IVORY ORIGINAL and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A -J, Exhibit L, Addendum 1, and <br />appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should <br />Ma be bound or in a 3 -ring binder; maps should be folded to 8 12" X 11" or 8 1/2" X 14" size. To expedite processing, please provide the information <br />in the format and order described in this form. <br />1. Applicant/operator or company name (name to be used on permit): r r l >5 fc Li. <br />1.1 Type of organization (corporation, partnership, etc.): 1 / <br /> <br /> <br />3. ?ermitted acreage (new or existing site): <br />3.1 Change in acreage ( +) <br />Total Acreage in Permit Area <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, In the space provided, ALL information described below. <br />4. Es: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34- 32.5 - 125(11)): <br />4.2 Conversion Fee (from 110d to 110 $875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be mined: a{.►. <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/I'ons/yr 2. / Ibs/Tons/yr 3. / lbs/Tons /w <br />4. / lbsions /yr 5. / lbs/Tons/ <br />5.2 Anticipated end use of primary commodities) to be mined: <br />5.3 Anticipated end use of incidental commodities) to be mined: <br />/ acres <br />94, acres <br />acres <br />$1.094.00 application fee <br />$719.00 application fee <br />