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DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (3031832 -8106 <br />REGULAR (112d) DESIGNATED MINING OPERATION <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />STATE 01 COLORADO <br />COLORAD <br />DRVVSIO H of O <br />MINERALS <br />GEOLOGY <br />IIlGLAHAflON•NINING <br />worry-science <br />SIIl Owens <br />Governor <br />Russell George <br />Executive Director <br />Ronald W. Canny <br />Division Director <br />Natural Resource Trustee <br />HECK ONE: New Application (Rule 1.4.5) )(, Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit No. M - (provide for amendments and conversions of <br />existing permits) <br />he application for a Regular (112d) Designated Mining Operation Reclamation Permit <br />:ontains three major parts: (1) the application form; (2) Exhibits A -T, Geotechnical <br />stability Exhibit, the Emergency Response Plan, and Addendum 1, as required by the <br />lffice, and outlined in Rules 6.1, 6.2, 6.3, 6.4.19, 6.5, 8.0, and 1.6.2(1)(b); and, (3) <br />he application fee. When you submit your application, be sure to include one (1) signed <br />and notarized Gray original and four (4) copies of the application form, five (5) copies <br />bf Exhibits A -T, Rule 6.5 Geotechnical Stability Exhibit, the Emergency Response Plan, <br />.ddendum 1, and a check for the appropriate application fee (described under Section (4) <br />n Page 2). Exhibits should not be bound or in a 3 -ring binders; maps should be folded to <br />%" X 11" or 8 Mu X 14" size. To expedite processing, please provide the information in <br />he format and order described in this form. <br />M MilefCne3:eam <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />Applicant /operator or company name (name to be used on permit): <br />L. /#zi Ate creZ fA.li wt eext Aide . <br />1.1 Type of organization (corporation, partnership, etc.): 6 <br />1.2 I.R.S. Tax ID No. or Socia]. Security Number: / / <br />Operation name (pit, mine or site name): 1lf 1Dt1(J f ,0 V6 <br />Permitted acreage: (new or existing site) 15#S48 acres <br />3.1 Change in acreage ( +) 95,0 acres <br />3.2 Total acreage in Permit area 36 4 8 acres <br />ad'.eee / /s$ z. d acs JP4 <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />