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I'o'. D~~ C-n / <br />CONSTRUCTION MATERIALS <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: V There is a File Plumber Already Assigned to this Operation <br />(,'{mot-~I '~ <br />RECEIVE® <br />JAN 0 3 20Q6 `~ <br />Dieision of Minerals and Geology <br /> <br />Perini[ # M -~-~-_ (Please reference the fi le/pumber currently assigned to this operation) <br />New Application (Rule 1.4.5) V Amendment Application (Rule 1.10) <br />Conversion Application (Rule L I I ) <br />Perini[ # M -~-~-_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (1) the <br />application form; (2) ExhibitsA-J, Exhibit L, Addendum ],any sections ofExhibit6.5 and Geotechnical Stability Exhibit, as required <br />by the Office, and outlined in Rules 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 <br />sure to include one (1) comolete sinned and notarized ORIGINAL and one (1) copy of [he completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 1/2" X <br />11" or 8 I/2" X l4" sizo. To expedite processing, please provide the information in the forma[ and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information ~d+e~sc~ribed below./ <br />1. ApplicanUoperator or company name (name to be used on Darin itl: h 1~ ~.A-t2<50fJ l ptt f \ ~~ <br />1.1 Type of organization (corporation, partnership, etc.): <br />2. Operation name (pit, mine or site name): <br />3. Permitted acreage (new or existine site): <br />3.1 Change in acreage (+) <br />3.2 Total Acreage in Permit Area <br />4. Fees: <br />4.1 New Application: <br />Amendment Fee (C.R.S. 34-32.5-125(11)): <br />4.2 Conversion Fee (from 11 Od to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />~~ permitted acres <br />- ~7 n~~7Q acres <br />`~I•~ y acres <br />1 094.00 application fee <br />$719.00 application fee <br />5. Primary commoditie(s) to be mined: , N~ ~jQ~ <br />5.1 Incidental commoditie(s) [o be mined: 1.1J~~/ lbs/i'ons/vr 2. / Ibs/Tons/vr 3. / Ibs/fons/vr <br />4. / Ibs/Tons/vr 5. / Ibs/rons/vr <br />5.2 Anticipated end use of primary commoditie(s) [o be mined: ~O'(~) MA 1 l~~~ <br />Anticipated end use of incidental commoditie(s) to be mined: <br />