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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY • — 2 3 7LJ <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 [COLOPKLADO <br />Phone (303) 866-3567 <br />DIVISION o f <br />RECLAMATION <br />FAX: (303) 832 -8106 MINING <br />SAFETY <br />DESIGNATED MINING <br />LIMITED IMPACT (I 10d) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: New Application (Rule 1.4) <br />Conversion Application (Rule 1.11) <br />FAmendment Application (Rule 1.8 or 1.10) <br />Permit # M- - (provide for Amendments and Conversions of existing permits) <br />The application for a Limited Impact (I 1 Od) Designated Mining Operation Reclamation Permit contains three major parts: (1) the application <br />form; (2) Exhibits A -J, Exhibit L, Exhibit T, the Geotechnical Stability Exhibit, the Emergency Response Plan, and Addendum 1, as required by <br />the Office, and outlined in Rules 6.1, 6.2, 6.3, 6.4.20 6.5, 8, and 1.6.2(1)(b); and (3) the application fee. When you submit your application, be sure <br />to include one (1) signed and notarized Original and one (1) copy of the application form, two (2) copies of Exhibits A -J, Exhibit L, Exhibit T, the <br />Geotechnical Stability Exhibit (Rule 6.5), the Emergency Response Plan (Rule 8), and Addendum 1 (Rule 1.6.2(1)(b)), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in 3 -ring binders; maps should be folded to 8 2" X 1 I " or 8 2" X <br />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. Applicantloperator or company name (name to be used on permit): Liberty Mining, LLC. <br />1.1 Type of organization (corporation, partnership, etc.): L.L.C. <br />1.2 I.R.S. Tax ID No. or Social Security Number: 20- 2836499 <br />2. Operation name (pit, mine or site name): Liberty Mine <br />RECRIVED <br />9.9 <br />3. Permitted acreage (new or existing site): <br />permitted acres <br />3.1 Change in acreage ( +) NOV 0 7 2013 <br />acres <br />Total Acreage in Permit Area <br />acres <br />DIVISION OF RECLAMATION <br />4. Fees: (Rule 1.5) MINING AND SAFM <br />4.1 New Application o R I G �N �� L <br />$2,875.00 application fee <br />41 Amendment Fee (operations existing as of 06/30194) <br />$1,725.00 application fee <br />4.3 Amendment Fee (operations permitted from 07/01i94) <br />$2300.00 application fee <br />4.4 After July 1, 1995, to convert a 110(1), 110(2) or a 110 to a 110(d), a new application form for a I 1 Od must be submitted, along <br />with an application fee of $2,875.00 (Rule 1.l 1.2(2)). <br />5. Primary commodities to be mined: Uranium and Vanadium <br />6. Type Surface W Underground 10 In <br />of mining operation: -situ <br />Office of <br />Office of <br />Mined land Reclamation Deriver • Grand Junction • Durango <br />Active and Inactive Mines <br />