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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 />STATE OF COLORADO <br />N D COLORADO <br />D I V I S I ON OF <br />RECLAMATION <br />MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: V There is a File Number Already Assigned to this Operation <br />Permit # W13 018 (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 _ 2013_ 018 _ (provide for Amendments and Conversions of existing permits) <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 I l "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 />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Applicant/operator or company name (name to be used on permit): Pine Bluffs Gravel & Excavating, Inc, <br />1.1 Type of organization (corporation, partnership, etc.): Corporation <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existine 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(II)): <br />5. Primary commoditie(s) to be mined: sand <br />Harms Pit <br />RECEIVED <br />APR 01 2013 <br />Division of Recipmstion, <br />Minin0 saw <br />gravel rock dirt <br />9.98 permitted acres <br />acres <br />acres <br />1258.00 application fee <br />827.00 application fee <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs /Tons /yr 2. / Ibs /Tons /vr 3. / lbs /Tons /vr <br />4. / lbs/Tons/yr 5. / lbs /Tons /yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: aggregate materials for road projects for US Government <br />Anticipated end use of incidental commoditie(s) to be mined: <br />