2012-02-07_REVISION - M1977443

• Permit No: M1977443
• IBM Index Class Name: REVISION
• Doc Date: 2/7/2012
• Doc Name: Submittal- No Money Received
• From: Hardrock Sand and Gravel
• To: DRMS
• Type & Sequence: AM1
• Email Name: SSS
• Media Type: D
• Archive: No

l7
DIVISION OF RECLAMATION, MINING AND SAFETY
Department of Natural Resources
1313 Sherman St., Room 215
Denver. Colorado 80203
Phone [phone]
FAX: [phone]
CONSTRUCTION MATERIALS
LIMITED IMPACT (110) OPERATION
RECLAMATION PERMIT APPLICATION FORM
CHECK ONE: There is a File Number Already Assigned to this Operation
1. Applicant/operator or company name (name to be used on hermit):
1.1 Type of organization (corporation, partnership, etc.):
2. Operation name (pit, mine or site name): friiai /✓ pit
3. Permitted acreage (new or existing site):
3.1 Change in acreage ( +)
3.2 Total Acreage in Permit Area
4. gm:
4.1 New Application:
Amendment Fee (C.R.S. 34-32.5- 125(II)):
4.2 Conversion Fee (from 110d to 110 52.696.00 conversion fee (Rule 1.11.2(2))
5. 3 coommodlt1Ms) to be mined: shim( &g ll $444-
5.1 Incidental commodities) to be mined: 1. / lbs/Tons/yr 2. /
4. / lbs/Tons/vr 5. /
5.2 Anticipated end use of primary commodities) to be mined:
Anticipated end use of incidental commodities) to be mined:
Office of
Mined land Reclamation Denier • Grand hmdion • Duran o
AMA/
STATE OF COLORADO
COLORADO
DIVISION Or
RECLAMATION
MINING
— &—
SAFETY
1 1
Bib Rik-, Jr.
Governor
Permit # __M_- _ (Please reference the fl l ....; currently assigned to this operation)
E. New Application (Rule 1.4.5) 1 % Amendment Application (Rule 1.10)
Conversion Application (Rule 1.11)
Permit # M -I9 7-7_ (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the
application form; (2) Exhibits A -3, Exhibit L, Addendum 1, any sections ofExhrbit 6.5 and Geotecbnical Stability Exhibit, as required
by the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the application fee. Whenyou submit your application, be
sure to include one (1) complete sinned and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies
of Exhibits A I, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for
the application fee described under (4) below. Exhibits should OT be bound or in a 3 -ring binder; maps should be folded to 81/2" X
11" or 8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, ALL information described below.
AiPFR'R6 SAI 4t R "e /
51.258.00
lbs/Tons/vr
l'Utt" - neat 777/v
permitted acres
4,c acres
.
5'6" acres
Marls D. Sherman
Enoecuave °hector
Ronald W. Canny
Division Meeker
Natural Resource Trustee
application fee
application fee
lbs/Tons/vr 3. / lbs/Tons/vr
Office of
Aw ve and Inactive Mines
CST