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STATE CIF 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 :N1 <br /> A D O <br /> Phone:(303)866.3567 RECTION <br /> FAX:(303)832.6106 M G <br /> SY <br /> LLNIITED IMPACT OPERATION(110(2)) <br /> RECLAMATION PERMIT <br /> APPLICATION FORNVI DECEIVED <br /> CHECK ONE: ® New Application Rule 1.4) Conversion Application(Rule 1.11) AUG 04 2 Q 14 <br /> Division of Reclamation, <br /> Permit#M- (provide for conversions of existing permits) Mining$gp fety <br /> ale/(r-I AIAC_ <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)steed and <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 tinder(4)below.Exhibits should not be bound <br /> or in a 3-ring binder;maps should be folded to 8 1/2"X 1 I" 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 /> I. Applicant/operator or company name(name to be used on the permit): Mineral Mountain Gold, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): LLC <br /> 2. Operation name(pit,mine or site name): <br /> Mineral Mountain Project <br /> 3. Permitted acreage(new or existing site): 9315 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $1,006.00 application fee <br /> 4.2 Amendment Application(from 1.10(2)) <br /> 4.3 Conversion Fee(from I10d to 110(2),(Rule I A 1.2(2)) $1.725.00 conversion fee <br /> 5. Primary commodities)to be mined: Gold <br /> 6. dame of owner to the surface of affected land: M inerex Corp <br /> 7. Name of owner to the subsurface riahts of affected land: Minerex Corp <br /> 8. Type of mining,operation: Surface a Underground 0 In-situ <br /> Office of Office of <br /> Mined Land Reclamation Denver • Grand junction • Durango Active and Inactive Mines <br />