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STATE OF COLORADO <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Shemm St., Room 215 <br />Denver, Colorado 80203 <br />COLORADO <br />DIVISION OF <br />` <br />Phone: (303) 866-3567 <br />RECLAMATION <br />FAX: (303) 8324106 <br />MINING <br />SAFETY <br />CONSTRUCTION MATERIALS <br />SPECIAL (III) OPERATION <br />Cs <br />TOO <br />4¢ <br />RECLAMATION PERMIT APPLICATION FORM <br />��ff <br />1 <br />The application for a Construction Materials Special l I 1 Operation Reclamation Permit contains four major parts: (1) the application farm; <br />(2) Exhibits A -L, Addendum 1, and any sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as required by the Office, and outlined in <br />Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2( 1)(b); (3) the application fee; (4) the Performance Warranty and if required a Financial Warranty. When <br />you submit your application, be sure to include one (1) completed, signed and notarized ORIGINAL and one (1) copy of the completed <br />application form, two (2) copies of Exhibits A -L, Addendum 1, appropriate sections of Exhibit 6.5 (Geotechnical Stability Exhibit), as <br />required, a check for the application fee described under (4) below, and the fully executed Performance Warranty and Financial Warranty, if <br />required. Exhibits should NOT be bound or in 3 -ring binders; maps should he folded to 8 2" X 1 i" or 8 2" X 14" size. To expedite <br />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 />I. Applicant/operator or comnany name (name to be used on the permit): <br />Ames Construction, Inc <br />1 I Type of organization (corporation, partnership, etc.): Corporation <br />2 Operation name (pit, mine or site name): Front Range Feed Lot Borrow <br />3 Permitted screaee: <br />4 New-Application.- <br />5 <br />ewApplication: <br />5 Primary commoditle(s) to be mined: Blowsand <br />6. Name or owner to the surface of affected land: <br />Front Range Feedlot Inc. <br />7. Name of owner to the subsurface riehts of affected land: Front Range Feedlot Inc. <br />S. Type or mining operation: 1,;.1 Surface a Underground a in•situ <br />Permitted Acres <br />Application Fee <br />9. Location information: The center of the area where the majority of mining will occur: <br />CO WaldCour.ty <br />PRINCIPAL MERIDIAN (check one): ' 6th (Colorado) 1 Oth (New Mexico) a Ute <br />SECTION (write number): S 18 <br />TOWNSHIP (write number and check direction): T 3 North South <br />RANGE (write number and check direction): R 64 East West <br />QUARTER SECTION (check one): NE NW SE SW <br />QUARTER/QUARTER SECTION (check one). NE ✓ NW SE SW <br />GENERAL DESCRIPTION: (the number of miies an 41 <br />erection from the nearest town and the approximate elevation): <br />15689 Welds runty Rd 49- Rangeland 16.6 miles North of 1-76 Kersey -Road Exit <br />0AX of <br />Mined land Reclamation <br />Denver • Grand )unction • Durango <br />Office of <br />Active and Inactive Mines <br />