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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Departnnent of Natural Riefources <br />1313 Sherman SL, Room 215 <br />COLORADO <br />Dever Colorado 803 <br />DIVISION O <br />Phone: (303) 86.3567 <br />FAX: (303) 832 8106 <br />MINING <br />SAFETY <br />REGULAR (112d) DESIGtiATED MINING OPERATION <br />RECLAMATION PERMIT <br />Bill Ritter, Jr. <br />Governor <br />APPLICATION FORM <br />his D. Slerryan <br />Executive Director <br />Ronald W. Canny <br />Division Director <br />Natural Resource Tr ustee <br />CHECK ONE: New Application (Rule 1.4.5) Amendment Application (Rule 1.10) <br />FConversion <br />Application (Rule 1.11) <br />Permit No. tit -1977 _451 (provide for amendments and conversions of existing permits) <br />The application for a Regular (112d) Designated tinning Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A -T, Geotechnical Stability Exhibit, the Emergency Response Plan, and Addendum 1, as required by the Office, and outlined in Rules <br />6.1, 6.2, 6.3, 6.4.19, 6.5, 8.0, and 1.6.2(l)(b); and, (3) the application fee. When you submit your application, be sure to include one (1) sip-ned sip-n and <br />n2glM Original and four (4) copies of the application form, five (5) copies of Exhibits A -T, Rule 6.5 Geotechnical Stability Exhibit, the <br />Emergency Response Plan, Addendum 1, and a check for the appropriate application fee (described under Section (4) on Page 2). Exhibits should <br />not be bound or in a 3 -ring binders; maps should be folded to 8 '%" X 11" or 8 'h" X 14" size. To expedite processing, please provide the <br />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 />Azw kantlowi*or or commav now (name to be need on permit): <br />Cotter Corporation N.S.L. <br />1.1 <br />1.2 <br />Type of organization (corporation, partnership, etc.): Corporation <br />LR.S. Tax ID No. or Social Security Number: 85- 0125530 <br />2. Operation same (pit, mine or site same): <br />3. Permitted acreare: (new or existing site) <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />SR -11 <br />13.30 permitted acres <br />0 acres <br />13.30 <br />acres <br />Office of Office of <br />Mined Land Reclamation Deriver • Grand )unction • Durango Alive and Inactive Mines <br />