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DIVISION OF MINERALS AND GEOLOGY <br />CONSTRUCTION MATERIALS n` ' / <br />Regular (112) Mining Operation / Ciro '- ~,/ <br />Application Worksheet/Checklist / <br />New App: Amendment App: Conversion App: X <br />Operator: High Plains Sand and Gravel, LLC Mine ID: M-1999-096 / <br />/Mine Name: Russell Gravel Pit Rec Date: 07/23/2004 ,/ <br />APPLICATION FORM (Rule 1.6.2 and 1.6.3): New application form submitted on 10/19/2009 <br />Application considered submitted on 11/08/2004 <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 />ADEQUACY COMMENTS <br />EXHIBIT A - 6.4.1 - LEGAL DESCRIPTION: / New Exhibit A submitted 10/19/2004 <br />EXHIBIT B - 6.4.2 - INDEX MAP: / New Exhibit B submitted 10/19/2004 <br />