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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />M- <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 8663567 <br />FAX: (303) 8328106 <br />STATE OF COLORADO <br />LIMITED IMPACT OPERATION (110(2)) <br />RECLAMATION PERMIT <br />APPLICATION FORM <br />CHECK ONE: ® New Application (Rule 1.4) 11 El Conversion Application (Rule 1.11) <br />J <br />Permit # M- r ' e%r conversions of existing permits) <br />COLORADO <br />DIVISION OF <br />RECLAMATION <br />MINING <br />SAFETY <br />The application for a Limited Impact Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A-J, any required sections of Exhibit S and Geotechnical Stability Exhibit, as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.4.19 and 6.5; and (3) the application fee. When you submit your application, be sure to include one (1) signed an <br />notarized original and one (1) copy of the application form, two (2) copies of Exhibits A -J, appropriate sections of 6.4.19 Exhibit S and 6.5 <br />(Geotechnical Stability Exhibit), as required, and a check for the application fee described under (4) below. Exhibits should not be bound <br />or in a 3 -ring binder; maps should be folded to 8 1/2" X 1l" or 8 1(2" X 14" size. To expedite processing, please provide the information <br />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 />-R <br />1. Appticantloyerator or company name (name to be used on the permit): V .,1 <br />C y— eftcx� <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (pit. mine or site name): ACE 1 N <br />+h e_ ho 1:c , C M C <br />L, <br />2 240 7T <br />3. Permitted acreage (new or existing site): <br />i <br />ct 9 permitted acres <br />• <br />4. Fees• <br />AUG 2 2013 <br />4.1 New Application <br />$1,006.00 application fee <br />4.2 Amendment Application (from 1.10(2)) <br />DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />4.3 Conversion Fee (from 114d to 110(2), (Rule 1, 11.2(2)) <br />$1.725.00 conversion fee <br />5. Primary commodities) to be mined: M 1-bn P_Y 0.1 <br />6. Name of owner to the surface of affected land: U . S <br />. Fo ye s -F S eY <br />V 1 C* <br />7. Name of owner to the subsurface rights of affected land: <br />8. Ty of mining operation: � <br />pe Surface E] Underground <br />F] In -situ <br />Office of Office of <br />Mined Land Reclamation Denver • Grand junction • Durango Active and Inactive Mines <br />