2012-02-16_REVISION - M2002020 (9)

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DIVISION OF RECLAMATION, MINING AND SAFETY Department of Natural Resources 1313 Sherman St., Room 215 Denver, Colorado 80203 Phone: (303) 866-3567 FAX: (303) 832 -8106 CHECK ONE: There is a File Number Already Assigned to this Operation Pet/ 20 02 020 M - _ (Please reference the file number currently assigned to this operati El Amendment Application (Rule 1.10) 4. Fees: 4.1 New Application 4.2 4.4 4.5 New Application (Rule 1.4.5) Conversion Application (Rule 1.11) Permit # M _ 2002 _ The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application fee descnbed under Section (4) below. Exhibits should NOT be bound 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 in the format and order described m this form. 3. Permitted acreage (new or existing site): 3.1 Change in acreage ( +) 3.2 Total acreage in Permit area GENERAL OPERATION INFORMATION Type or print clearly, in the space provided, ALL information requested below. 1. Applicant/operator or company name (name to be used on permit): City of Greeley 1.1 Type of organization (corporation, partnership, etc.): Municipality 2. Operation name (pit, mine or site name): 25th Avenue Site New Quarry Application Amendment Fee Conversion to 112 operation (set by statute) 5. Primary commoditie(s) to be mined: sand 5.1 Incidental commodities) to be mined: 3. / 1. n/a lbs/Tons/vr 4. / gravel STATE OF COLORADO CONSTRUCTION MATERIALS REGULAR (112) OPERATION RECLAMATION PERMIT APPLICATION FORM (provide for Amendments and Conversions of existing permits) 87.05 197.51 284.56 $2,696.00 $3,342.00 $2,229.00 $2 696.00 COLORADO D I V I S I O N O F RECLAMATION MINING — &— SAFETY Bill Ritter, Jr. Governor Hams D. Sherman Oltiecutive Director Ronald W. Cattany Division Director Natural Resource Trustee permitted acres acres acres application fee quarry application amendment fee conversion fee lbs/Tons /vr 2. / lbs /Tons /yr lbs/Tons/vr 5. / lbs/Tons/yr 5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Materials 5.3 Anticipated end use of incidental commoditie(s) to be mined: n/a Office of Office of Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines