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COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAI L5 U 16 U U L�=3 <br />Department of Natural Resources <br />1313 Sherman St., Room 215 �y n +� <br />MAR O Z 2C12 <br />KA O <br />tR;ECLAMATION <br />Denver, Colorado 80203 <br />D <br />Phone: (303) 866.3567 <br />I O N O F <br />FAX: (303) 832106 <br />DURANGO FIELD OFFICE <br />N I NG <br />DIVISION OF RECLAMATION, <br />_ _ <br />SAFETY <br />MINING AND SAFETY <br />CONSTRUCTION MATERIALS <br />Z� l ,Z -- a � <br />Bill Ritter, Jr. <br />LIMITED IMPACT (110) OPERATION <br />Governor <br />Harris D. Sherman <br />RECLAMATION PERMIT APPLICATION FORM <br />Executive Director <br />Ronald W. Cattany <br />Division Director <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Natural Resource Trustee <br />Permit # M -_ -_ (Please reference the umber currently assigned <br />to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M - - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (I 10) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) Exhibits A -J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required <br />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. When you submit your application, be <br />sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies <br />of Exhibits A -J, Exhibit L, Addendum 1, and appropriate sections of 6.5 ( Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3 -ring binder; maps should be folded to 81 /2" X <br />11" or 8 1/2" X 14" size. To expedite processing, please provide the information 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 />1. Applicant/oyerator or company name (name to be used on permit): ` R O N IC Kt= �XCrQ I//Q 7�yNG t / NG . <br />1.1 Type of organization (corporation, partnership, etch.): C 0 R 100 9/4 7-10-11/ <br />2. Operation name (ift mine or site name): C7 /S QL4 t� K J0 I T tom'` <br />3. Permitted acreage (new or existing site): 9, 8 d permitted acres <br />3.1 Change in acreage ( +) �_ acres <br />3.2 Total Acreage in Permit Area U acres <br />4. Fees <br />4.1 New Application: $1,258.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(11)): $827.00 application fee <br />4.2 Conversion Fee (from 110d to 110 $2,696.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commodities) to be mined: -'�A A),D tM V& 15 Dile 7— <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/Tons/vr 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br />4. / lbs/Tons /vr 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commodities) to be mined: f �i7,417 Asc. ST %f 57- 4C f LI &44- A-I // <br />Anticipated end use of incidental commodities) to be mined: NA <br />Office of Office of <br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines <br />