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DIVISION OF RECLAMA'T'ION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman SL. Room 215 <br />Denver. Colorado 60203 <br />Phone: (303) 866-3567 <br />FAX (303) 832-8106 <br />STATE OF COLORADO <br />RECEIVED <br />t,�M 0 3 2017 <br />ONIU)N OF RULAMM <br />Wt1i1i11IMAO SAFETY <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: n There is a File Number Already Assigned to this Operation <br />t <br />RADO <br />ION o rMATIONING <br />&-- <br />ETY <br />Permit # M -_ (Please reference the file number currently assigned to this operation) <br />New Application (Rule I A.5) a Amendment Application (Rule 1.10) -A M Y� <br />Conversion Application (Rule 1.11) <br />Permit # M 1997 1115 (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 (l) compgte 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 NOT be bound or in a 3 -ring binder; maps should be folded to <br />8 112" X 1 V or 8 112" X 14" size. To expedite processing, please provide the information in the format and order described in this fano. <br />J Annual Fee/Report: PD 12/19/16 <br />V Violations: <br />MV -2016-019 3/09/2016 VA 4/01/16 <br />MV -2016-050 8/24/2016 AB 9/3016 <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, In the space provided, ALL information requested below. <br />1. Aunlicantlonerator <br />or comnallyname (name to be used gn aermitl: Washington County <br />^_ <br />1.1 <br />Type of organization (corporation, partnership, etc.): Govemment <br />2. Operation <br />name (nit. mine or site namel: EINCh Pit <br />3. Permitted <br />acreatew or istin site : <br />51.7 <br />permitted acres <br />3.1 <br />Change in acreage (+) <br />0.5 <br />acres <br />3.2 <br />Total acreage in Permit area <br />52.2 <br />acres <br />4. EM: <br />4.1 <br />New Application <br />$2.696.00 <br />application fee <br />4.2 <br />New Quarry Application <br />S3.342.OQ, <br />quarry application <br />4.4 <br />Amendment Fee <br />_$2.22900 <br />amendment fee <br />4.5 <br />Conversion to 112 operation (set by statute) <br />$2.696.00 <br />conversion fee <br />5. Primary <br />commoditie(s) to be mined: gravel sand <br />5.1 <br />Incidental commodities) to be mined: 1. - lbs/ion /sir <br />2. / <br />lbs/Tons/yr <br />3. I lbs/Tons/yr 4. I I <br />5. 1 <br />„IklMns/vr <br />5.2 <br />Anticipated end use of primary commoditie(s) to be mined: road surfacing <br />5.3 <br />Anticipated end use or incidental commoditie(s) to be mined: fill dirt <br />J Annual Fee/Report: PD 12/19/16 <br />V Violations: <br />MV -2016-019 3/09/2016 VA 4/01/16 <br />MV -2016-050 8/24/2016 AB 9/3016 <br />