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m <br /> a III IIIIIIIIIIIII III • <br /> TAT OF COLORADO <br /> DIVISION OF MINERALS AND GEOLOGY <br /> Depa1313 She m 01 St.,P,al Resources <br /> 1313 Sherman St.,Room 215 ' <br /> Denver,Colorado 80203 D I v 15 1 0 N O F <br /> Phone:13031 67 �YX M t N E R A L 5 <br /> F&V 53(131832-8102-8106 -J & <br /> GEOLOGY <br /> RCf1 A L C E R^ O\ ( \ MATION <br /> tC�IIJJ tC / \J MINING-SAFETY <br /> 1VED ON <br /> CONSTRUCTION MATERIALS <br /> MAY 2 6 1999 B'11 owe°' <br /> LIMITED IMPACT(110)OPERATION Governor <br /> Division Of Minerals&Geology RECLAMATION PERMIT APPLICATION FORM E.Kmn,e D iecior <br /> i <br /> Michael B.Long <br /> ,eon <br /> / Division D"edor <br /> CHECK ONE: V New Application(Rule 1.4) Conversion Application(Rule 1.11) <br /> Amendment A plication(C.R.S.34-32.5-110) <br /> Permit# � (provide for Amendments and Conversions of existing permits) <br /> The application for a Construction Materials Limited Impact(I 10)Operation Reclamation Permit contains three major parts: (])the application form; <br /> (2)Exhibits A-J,ExhibitL,Addendum 1,any sections of Exhibit 6.5 and Geotechnical Stability Exhibit,as required by the Office,and outlined in Rules <br /> 6.1, 6.2,6.3,6.5,and 1.6.2(1)(b); and(3)the application fee. When you submit your application,be sure to include one(1) complete signed and <br /> notarized IVORY ORIGINAL and one(1)copy of the completed Ivory application form,two(2)copies of Exhibits A-J,Exhibit L,Addendum 1,and <br /> appropriate sections of 6.5(Geotechnical Stability Exhibit),as required,and a check for the application fee described under(4)below. Exhibits should <br /> NOT be bound or m a 3-ring binder,maps should be folded to 8112"X I I"or 812"X 14"size. To expedite processing,please provide the information <br /> 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. Anolitcant/operator or company name(name to be used on permit): Lf4S M. ✓4 Sgtce z <br /> 1.1 Type of organization(corporation,partnership,etc.): Se-LP Erm4 J_0% _( <br /> 1.2 I.R.S.Tax ID No.or Social Security Number: S—A 1 — '2 J-- 116?/A <br /> 2. ODeration name(pit,mine or site name): 1ben ed U�oL F QUCl,'f!K1 /' <br /> 3. Permitted acreage(new or existing site): 9,C*permitted acres <br /> 3.1 Change in acreage acres <br /> Total Acreage in Permit Area 7•Y03 acres <br /> 4. Fees: <br /> 4.1 New Application: $875.00 application fee <br /> Amendment Fee(C.R.S.34-32.5-125(li)): $575.00 application fee <br /> 4.2 Conversion Fee(from 110d to 110$875.00 conversion fee(Rule 1.11.2(2)) <br /> 5. Primnry commoditie(s)to be mined: SA/l2J 4)Q_ <br /> 5J Incidental commoditie(s)to be mined: I. Ibs/Tons/vr 2. i�"7)— Ibs/Tons/vr 3. 1'9/ Ibsrrons/vr <br /> 4. TD- Ibs/rons/vr 5. 'P= IbsJons/vr 1 / <br /> 52 Anticipated end use of primary commoditie(s)to be mined: Cr, k)s/luc.'iwA) A-k)d /_..4,tJe�SC.tMia4 w�/ <br /> 5.3 Anticipated end use of incidental commoditie(s)to be mined: f J 6_2 LA5¢�A Nfk J�:t ZL-AAJ11 /Q�Ii4r iW-a.S <br />