2012-03-14_PERMIT FILE - M2012004 ‎(3)‎

• Permit No: M2012004
• IBM Index Class Name: Permit File
• Doc Date: 3/14/2012
• Doc Name: ‎(110)‎ APPLICATION FORM
• From: SOFS
• To: DRMS
• Email Name: ECS
• Media Type: D
• Archive: No

DIVISION OF RECLAMATION, MINING AND SAFETY
Department of Natural Resources
1313 Sherman St, Room 215
Denver, Colorado 80203
Phone [phone]
FAX: [phone]
CHECK ONE:
CONSTRUCTION MATERIALS
LIMITED IMPACT (110) OPERATION
RECLAMATION PERMIT APPLICATION FORM
GENERAL OPERATION INFORMATION
Type or print clearly, In the space provided, ALL information described below.
3. Permitted acreage (new or existing site):
3.1 Change in acreage ( +)
3.2 Total Acreage in Permit Area
4. Fees:
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. Primary commoditie(s) to be mined: 1: 1 . O 1 ttr
Office of
Mined Land Reclamation Denver • Grand Junction • Durango
STATE OF COLORADO
51,258.00
5827.00
COLORADO
D IVISION O F
RE CLAMATION
MINING
— &—
SAFETY
sill Ritter, Jr.
Governor
Harris D. Sherman
Executive Director
Ronald W. Cattany
Division Director
Natural Resource Trustee
There is a File Number Already Assigned to this Operation
Off il
Permit # M - Z(�! Z _ - ( (Please reference the 1 umber currently assigned to this operation)
_E_ New Application (Rule 1.4.5)
Conversion Amendment Application (Rule 1.10)
Application (Rule 1.11 )
APP (R
Permit # M - - (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 -J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical 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. 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 -J, 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 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 in this form.
1. Applicant/operator or company name (name to be used on permit): 5() ai0t( bk FU t-j) X i11245 CO r ) L / /i
1.1 Type of organization (corporation, partnership, etc.): LI. -C.
2. Operation name (pit, mine or site name): A)OP- & S-
permitted acres
acres
acres
application fee
application fee
5.1 Incidental commoditie(s) to be mined: 1. )00410 lbst 'r 2. / lbs/Tons/vr 3. / lbs/Tons/vr
4. / Ibs/Tons/vr 5. / lbs/Tons/yr
5.2 Anticipated end use of primary commoditie(s) to be mined:
Anticipated end use of incidental commoditie(s) to be mined: gin PA-0 C(Th$17(ry GT)(31�
Office of
Active and Inactive Mines