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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,INNING AND SAFETY <br /> beimunent of NakM 11mmum <br /> RECEIVE 0 <br /> 1313 Sheen en St.,Roan 215 vim e+dq: #L�O R ADO <br /> Denver,Colorado 8=3 D IV S I ON Of <br /> Phone:(303)866-3567 JUN 2 3 2016 RECLAMATION <br /> FAX:(303)832-6106 MINING <br /> DIVISION OF RFCLAMAPI)NJ SAF ETY <br /> MINING AND SAFE Y <br /> CONSTRUCTION MATERIALS <br /> REGULAR(112)OPERATION <br /> RECLAMATION PERMIT APPLICATION FORM <br /> CHECK ONE: There is a File Number Already Assiped to this Operation <br /> Permit# vM - - — (Please reference the file number currently assigned to this operation) <br /> New Application(Rule 1.4.5) a Amendment Application(Rule 1.10) <br /> Conversion Application(Rule 1.11) <br /> Permit# M nQ - 010 - (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) 2MLIete sipmed and notarized ORIGINAL and one(1) copy of the completed <br /> application form,two(2)copies of Exhibits A-S,Addendum 1,appropriate sections of6.5(Geotedutical Stability Exhibit,and a check for <br /> the application fee described under Section(4)below. Exhibits should NOT be bound or in a 3-ring binder;traps 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,As Information.requested below. tp� <br /> 1. Apu1'�t/operator or company name(name to be used on permit): t(Or'rn ti.\� 1EXd -%%toa2 kk l NV ItA 11C <br /> 1.1 Type of organization(wrporation,partnership,etc.): <br /> 2. Operation name(nit,mine or site name): <br /> 3. permitted a (new or existing site): C _ permitted acres <br /> 3.1 Change in acreage(+) — 9 acres <br /> 3.2 Total acreage in Permit area 5.4 acres <br /> 4. Fees: <br /> 4.1 New Application S2-696.00 application fee <br /> 4.2 New Quarry Application S3342.00 quarry application <br /> 4.4 Amendment Fee S2.229.00 amendment fee <br /> 4.5 Conversion to 112 operation(set by statute) g2.6%.00 conversion fee <br /> 5. Primary commoditie(sl_to be uined: ,spm� _ <br /> 5.1 Incidental commodities)to be mined: I. v f A - lbs/Tons/vr 2. Ibs(rons/vr <br /> 3. JjA / 1bsrlbns/vr 4. lbs/Torts/vr 5. t 1�� I Ibs/ronshT <br /> 52 Anticipated end use of primary commodities)to be mined:�^w,. s.��oa 1=a r'k, U t-e- <br /> 5.3 Anticipated end use of incidental oommoditie(s)to be mined: i'U 1 A <br />