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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 C O L O R ADO <br />Phone: (303) 866 -3567 D r V IS t A N o f <br />FAX: (303) 832 -8106 RECLAMATION <br />MINING <br />SAF ETY <br />CONSTRUCTION MATERIALS D ( R <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FOR AUG 16 200 <br />CHECK ONE: 11 There is a File Number Already Assigned to this Operation <br />Permit # M - - (Please reference the file number currentl assign to thrs <br />New Application (Rule 1.4.5) Amendment Application (Rule L I0) <br />Conversion Application (Rule 1.11) <br />Permit # M - - - (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: (I) 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 81/2" 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 />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Applican (name to be used on permit): j�r2 �/ L-3D YC <br />1.1 Type of organization (corporation, partnership, etc.): �x,�+✓ u, v :l t, S 4 L- C_ <br />2. Operation name (pit, mine or site name): C o n ai("� R? i_— <br />3. Permitted acreage (new or existing site): RECEIVES permitted acres <br />3.1 Change in acreage ( +) <br />3.2 Total Acreage in Permit Area <br />,,I I(' ?n ?013 <br />4. Fees: <br />4.1 New Application: DIVISION OF RECLAMATION <br />Amendment Fee (C.R.S. 34- 32.5- 125(II)): MINING AND SAFETY <br />5. Primary commoditie(s) to be mined: <br />acres <br />acres <br />1258.00 application fee <br />$827.00 application fee <br />5.1 Incidental commoditie(s) to be mined: 1. / Ibs/Tons /yr 2. / Ibs/Tons /yr 3. / lbs/Tons /yr <br />4. / Ibs/Tons /vr 5. / lbs/Tons /vr ,, A <br />5.2 Anticipated end use of primary commoditie(s) to be mined: >eo,4 o B4:5r- f F1 c t /t' 4r2-W 11f LS' <br />Anticipated end use of incidental commoditie(s) to be mined: /(/o Ai <br />