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s STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Deparby n of Natural Rmwces <br /> 1313 Shenn n SL,Room 215 61V <br /> Denver,Colorado 80203 C O L O R A D O <br /> Phone:(�)�-� REC DIVISION <br /> LAMATION <br /> FAX(303)832-8106 MINING <br /> SAFETY <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: X There is a File Number A ready Assigned to this Operation <br /> Permit# M -1997 -039 (Please reference the Ede.number currently assigned to this operation) <br /> New Application(Rule IA.5) Amendment Application(Rule 1.10) <br /> X Conversion Application(Rule 1.11) <br /> Permit# M -1997 -039 (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts:(1)the application <br /> form;(2)Exhibits A S,Addendum 1,any sections of Exhibit 6.5(Geotechnical Stability Exhibit;and(3)the application fee. When you <br /> submit your application, be sure to include one (1) complete signed and notarized ORIGINAL and one (1) copy of the completed <br /> application form,two(2)copies of Exhibits A-S,Addendum 1,appropriate sections of 6.5(Geotechnical Stability Exhibit,and a check for <br /> the application fee described under Section(4)below. Exhibits should DW be bound or in a 34M binder;maps should be folded to <br /> 8 1/2"X I I"or 8 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 requested below. <br /> I or Redi-Mix C MW <br /> 1.1 Type of organization(corporation,pip,etc.): carporation <br /> 2. [ r.� ��(N:r-mine or sitename): Williams/Mmois Gravel Pit <br /> 3. Perms %d acrea:e faew or WAKNZ t g site): 9.99 acres <br /> 3.1 Change in acreage(+) acres <br /> 32 Total acreage in Permit area 204.82 acres <br /> 4. EM <br /> 4.1 New Application OCT 17 2 014 $2.696.00 application fee <br /> 4.2 New Quarry Application $3,342.00 quarry application <br /> 4.4 Amendment Fee DIVISION OF RECLAMATION $2,229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) MINING AND WLITy $2,696.00 conversion fee <br /> 5. Crinna commodifiefsI to be mined: Sand Gravel <br /> 5.1 Incidental commodities)to be mined: 1. - lbs/Tons/vr 2. / lbslTonsh+r <br /> 3. / Ibs/Tons/yr 4. / lbs/Tons/vr 5. / Ibs/I ons/vr <br /> 52 Anticipated end use of primary commoditie(s)to be mined: Road C,onstruWon and CansWdion Materials <br /> 53 Anticipated end use of incidental commodities)to be mined: <br />