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• COLORADO sJM. GRM RECEIVED <br /> AMYDivision of Reclamation, M-2017-035 <br /> Mining and Safety AUG 31 2017 <br /> Department of Natural Resources Humming Bird Mine <br /> DIVISION OF RECLAMATION <br /> 1313 Sherman Street, Room 215 MINING AND SAFETY <br /> Denver,CO 80203 <br /> LIMITED IMPACT OPERATION(110(1)) <br /> RECLAMATION PERMIT <br /> APPLICATION FORM <br /> h <br /> CHECK ONE: _a New Application <br /> Permit#M- (provide for conversions and amendments of existing permits) <br /> The application for a Limited Impact 110(1) Mining Operation Reclamation Permit contains three major parts: (1)the application form; <br /> (2)Exhibits A-J,any required sections of Exhibit S and Geotechnical Stability Exhibit,as required by the Office,and outlined in Rules 6.1, <br /> 6.2,6.3,and 6.5;and(3)the application fee. When you submit your application,be sure to include one(1)sieved and notarized original <br /> and one(1)copy of the application form,two(2)copies of Exhibits A-J,and 6.5(Geotechnical Stability Exhibit),as required,and a check <br /> for the application fee described under(4)below.Exhibits should not he bound or in a 3-ring binder;maps should be folded to 8 1/2"X <br /> 11"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 described below <br /> 1. Applicant/operator or company name(name to be used on the permit): Miners Mall, LLC <br /> 1.1 Type of organization(corporation,partnership,etc.): limited Liability Corporation <br /> 2. Operation name(pit mine or site name): Humming Bird Mine <br /> 3. Permitted acreage(new,or existing):(must be 5 acres or less) 0.10 permitted acres <br /> 4. Fees: <br /> 4.1 New Application $288.00 application fee <br /> 5. Primary commodities)to be mined: Amethyst, Fluorite, Copper Mineral Specimens <br /> 6. Name of owner to the surface of affected land: Bureau of Land Management <br /> 7. Name of owner to the subsurface rights of affected land: Dennis Schneider&Tammey Holbrook <br /> 8. Type of mining operation: R1 Surface Fl Underground OPlacer <br /> OF COLO <br /> ;? O <br /> 1313 Sherman Street,Room 215,Denver,CO 80203 P 303.866.3567 F 303.832.8106 http://mining.state,.CO.US <br /> *1876 <br />