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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman SL, Room 215 <br />Demrer, Colorado 80203 <br />COLORADO <br />Phone: (303) 666 -3567 <br />DIVISION o r <br />RECLAMATION <br />FAX: (303) 832 -8106 <br />MINING <br />SAM Y <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE n is a File Number Already Assigned to this Operation <br />P 't # M - (Please reference the file number currently assigned to this operation) <br />IR: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 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 signed and notarized ORIGINAL 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 h= 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, AL information requested below. <br />1. r : u L r=*RrANO Ca, Airy G oyumptEKr <br />1.1 Type of organization (corporation, partnership, etc.): vc4 Abc <20IlNiy <br />3. Permitted acreage (new or existin¢ site): <br />3.1 Change in acreage ( +) <br />3.2 Total acreage in Permit area <br />4. &a- <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 />-31.0 permitted acres <br />acres <br />3I • -acres <br />--Io- S2.6 %.00 application fee <br />S3.342.00 quarry application <br />52.229.00 amendment fee <br />52.696.00 conversion fee <br />5. Primary commoditie(s) to be mined: SQ-� VeL_ lZn4D3�F' 'i� U2Qow <br />5.1 Incidental commoditie(s) to be mined: 1. 0 Ibs/Tons/vr 2. © / ibs/Tons/vr <br />3. / lbs/Tons/vr 4. O / lbs/Tons/vr 5. /Z1i / lbs/Tons/vr <br />52 Anticipated end use of primary commoditie(s) to be mined: J4 U EZF P K 0 C O UNN '�,'O A b s <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: N Z R <br />