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ILE COPY <br />fQR SCA <br />OF COLORADO IJ <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources RECE9~JED <br />1373 Sherman 8t., Room 215 <br />Denver, Colorado 80203 ~~~ ~ ~ .~nn~ <br />Phone: (303) 866-3567 .7Pi <br />FAX: (303) 832-8106 <br />bivision of Minerals and Geology <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />R E C L A M A T I O N <br />MINING•SAFETY <br />8111 Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />CHECK ONE: %New Applicaflon (Rule 1.4.5) _ Amendment Applicafion (Rule 1.1 ichael B. long <br />~ivision Director <br />Conversion Application (Rule 1.11) <br />Permit # ~-~LCOj -~-~ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical StabilityExltibit; and (3) the application fee. When you submit your <br />applicafion, be stare to include one (I) complete siened and notarized IVORY ORIGINAL and fora (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the . <br />applicator fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1R" X 11" <br />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 cleazly, in the space provided, ALL information requested below. <br />Aoulicant/ooeratot or company name (name to be used on permit): Coulson Excavating Company, Inc. <br />1.1 Type oforganization (corporation,pazmetship,etc.): Corporation <br />1.2 LR.S. Taz LD. No. or Social SecurityNumber: 84-0702158 <br />2, <br />3. <br />Operation name (pit, mine or site name): Stroh Pit <br />Permitted acteaee (new or etdstina site): <br />3.1 Change in acreage (+) <br />119 permitted acres <br />0 acres <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operafion (set by statute) <br />5. Primary commoditie(s) to be mined: gravel <br />5.1 Incidental commoditie(s) to be mined: 1. lbs/1'ons/yr <br />119 acres <br />$2.344.00 application fee <br />$2.906 00 quarry application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / lbs/I'ons/vr <br />3. / 1bs/Tons/kr 4. / 1bs/fons/yr 5. / lbs/Tons/vr <br />5.2 Anticipated end use ofpzimarycommodifie(s)tobemined: asphalt hot mix and raw road base <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />