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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX (303) 832 -8106 <br />RECEIVED <br />MAR 1 1 2013 c / i J <br />STATE OF COLORADO <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />DIVISION OF RECLAMATION RECLAMATION PERMIT APPLICATION FORM <br />MINING AND SAFETY -- <br />CHECK ONH: ❑ There is a File Number Already Assigned to this Operation <br />P it # jvl _ - (Please reference the file number currently assigned to this operation) <br />New Application (Rule 1.4.5) I ._ Amendment Application (Rule 1.10) <br />_ Conversion Application (Rule 1.11) <br />Permit # M - 7 - (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete sinned juingtimincmpAya and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should OT be bound or in a 3 -ring binder; maps should be folded to <br />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. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information requested below. <br />1. A nnlicant/onerator or company name (name to be used on ermit): K R>r A & O C& (nh.( t7 °v /04E10 <br />l.1 Type of organization (corporation, partnership, etc.): £..vLORAIN q CC) v D' <br />2. Operation name (nit, mine or site name): OI PI4 IkIst V 1 Fw G 4\E. <br />3. Permitted acreage (new or existing site): <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />4.: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commodities) to be mined: , g4141) <br />q(vra <br />-+ $2.696.00 <br />$3.342.00 <br />$2.229.00 <br />$2.696.00 <br />permitted acres <br />acres <br />acres <br />application fee <br />quarry application <br />amendment fee <br />conversion fee <br />IRA nt_ *- Rn+4DB 45E l302QAw <br />C.) / <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/Tons/yr 2. O / Ibs/Tons/vr <br />3. / lbs/Tons/vr 4. lbs/Tons/vr 5. a / lbs Tons/yr <br />5.2 Anticipated end use of primary commodities) to be mined: Li E iZP A a° Co U NT ( 'O A bi <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N /A. <br />