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• <br />• L <br />• <br />8. <br />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 />OCT 1 A2011 <br />Division of Reclamation, <br />Mining & Safety <br />CHECK ONE: El New Application (Rule 1.4) <br />2. Operation name (pit, mine or site name): <br />Office of <br />Mined land Reclamation <br />1e of mining operation U Surface <br />LIMITED IMPACT OPERATION (110(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />Conversion Application (Rule I.11) <br />977 4 O X Amendment Application <br />Permit # M- (provide for conversions of existing permits) <br />The application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (I) the application <br />form; (2) Exhibits A J, any required sections of Exhibit S and Geotechnicai Stability Exhibit, as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure to include one (I) signed and <br />notarized original and one (1) copy of the application form, two (2) copies of Exhibits A J, appropriate sections of 6.4.19 Exhibit S and 6.5 <br />(Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should not be bound <br />or in a 3 -ring binder; maps should be folded to 8 1/2" 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 />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 the permit): Calais Resources Colorado, Inc. <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />Cross Mine <br />3. Permitted acreage (. m r existing site): <br />Additional acres: <br />4. F Total acres: <br />4.1 New Application <br />4.2 Amendment Application (from 1.10(2)) <br />4.3 Conversion Fee (from 110d to 110(2), (Rule 1.11.2(2)) <br />5. Primary com to be alined Gold, silver, lead, zinc, copper <br />STATE OF COLORADO <br />ie) filo <br />6. Name of owner to the surface of affected land: Calais Resources Colorado, Inc. <br />7. Name of owner to the subsurface ri is of affected land: Calais Resources Colorado, Inc. <br />r-� <br />Underground LJ in -situ <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />Bin Ritter, Jr. <br />Governor <br />Harris D. Sherman <br />Executive Director <br />Ronald W. Catrany <br />Division Director <br />Natural Resource Trustee <br />2.0 permitted acres <br />9.35 <br />7.35 <br />$1,006.00 application fee <br />$661.00 application fee <br />$1.725.00 conversion fee <br />Denver • Grand Junction • Durango <br />Active and Inactive Mines <br />Office of <br />