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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman Si, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866 -3567 <br />FAX: (303) 832 -8106 <br />STATE OF COLORADO <br />/ -k003 -o©, <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Pe it # M - - (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />Permit # M -2o )3- CO6 - (provide for Amendments and Conversions of existing permits) <br />1.1 Type of organization (corporation, partnership, etc.): S • c_c r p <br />2. Operation name (pit, mine or site name): <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />3. Permitted acreage (new or existing site': <br />3.1 Change in acreage ( +) <br />3.2 Total Acreage in Permit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34- 32.5 - 125(11)): <br />1 10 4- -1) <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />RE CEIVED <br />FEB 0 12013 <br />v SIONOFRE <br />MININGAND SA <br />The application for a Construction Materials Limited Impact (110) 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 by <br />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 <br />to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed application form, two (2) copies of <br />Exhibits A -J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the <br />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 <br />1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form. <br />1. Applicant/operator or company name (name to be used on permit): r t1 t 11 1 t .c <br />9 r 98 permitted acres <br />acres <br />9 . 9 F acres <br />$1 258.00 application fee <br />$827.00 application fee <br />5. Primary commoditie(s) to be mined: ( r 1 €0611 e-- <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/Tons/yr 2. / lbs /Tons /yr 3. / lbs/Tons/yr <br />4. / Ibs/Tons/yr 5. / lbs/Tons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Con S t 1" -- +1 c t'1 n - fe t' 1 c, t S <br />Anticipated end use of incidental commoditie(s) to be mined: <br />