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DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS <br />Regular (112) Mining Operation <br />Application Worksheet/Checklist / <br />New App: <br />Operator: <br />Mine Name <br />X Amendment App: Conversion App: <br />Clear Creek District Water Providers, LLC / Mine ID: M-2004-067/'~ <br />MtfitR Quarry ~ Date: ii/09/2004 ./ <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): <br />ITEMS <br />COMPLETED 1 2 3 4 5 6 <br /> / / / / / / <br />ITEMS <br />COMPLETED 7 8 9 10 11 12 <br /> / / / / / / <br />ITEMS 13 14 Description Responsibilities Signature <br />COMPLETED of Of a <br /> Amendment permittee <br /> / / / / <br />MAPS and EXHIBITS (Rule 6.2) <br />EXHIBIT A - 6.4.1 - LEGAL DESCRIPTION: / <br />ADEQUACY COMMENTS <br />EXHIBIT B - 6.4.2 - INDEX MAP: / <br />