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TATE O~ COLORADO <br />DIVISION OF MINERALS AND GEOLOGY , ~ VED <br />Department of Natural Resources <br />1313 Sherman St., Room 215 SUN 21 1003 <br />Denver, Colorado 80203 D t V I S I o N o r <br />Phone: (303) 866-3567 Division ~t MINERAL S <br />Fnx: (303) 63z-ato6 CONSTRUCTION MATERIALS Minerals and Geology S` <br />GEOLOGY <br />LIMITED IMPACT (110) OPERATION R E C L A M A T I O N <br />MINING•SAFETY <br />RECLAMATION PERMIT APPLICATION FORM <br />Bill Owens <br />Governor <br />Greg E. Walther <br />CHECK ONE: X There is a File Number Already Assigned to this Operation Executive Director <br />Ronald W. Canany <br />t/ rermit # M - 19 _ 98 _052 (please reference the file nttmber ctuTently assigned to this operation) Acting Division Director <br />New Application (Rule 1.4.5) X Amendment Application (Rule 1.10) <br />Conversion Appication (Rule 1.11) <br />Permit # M - 19 - 98 _052 (provide for Amendments and Conversions of existing permits) <br />The application for a Constmction Materials Limited Impact (110) Operation Reclamation Petmit contains three major parts: (1) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotecltnical Stability Exhibit, as required by the <br />Office, and outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(I)(b); and (3) the application fee. When you submit your application, be sure to <br />include one (1) comolete sued and notarized IVORY ORIGINAL and one (1) copy of the completed IvOI~r application fotm, two (2) copies <br />of Exhibits A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geoteclutical Stability Exhibit), as required, and a check for the <br />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 11" or <br />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 clearly, in the space provided, ALL information described below. ~~ - /~ <br />1. Ao oticauUooerator or comoanv name (name to be used on Dermit): Rock I51 dnd Land CO. , LLC '~ <br /> 1.1 Type of organization (corporation, partnership, etc.): LLC <br /> 1.2 I.RS. Tax ID No. or Social Security Number: 2.: <br />2. OD erationname(Dk.mineorsitename): ROCk ISldrid Operation r~ <br />3. Permitted acreage (new or existing site): 1.94 permitted acres <br /> 3.1 Change in acreage (+) 8.00 acres <br /> 3.2 Total Acreage in Permit Area 9.94 acres <br />4. Fees: <br /> 4.1 New Application: $1.094.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)): $719.00 application fee <br /> 4.2 Conversion Fee (front 110d to 110 $875.00 conversion fee (Rule 1.11.2(2)) <br />5. Primarvcommoditie(s)tobemined: sdnd gravel road-base rip-rap etc. <br />5.1 Incidental commoditie(s) to be mined: ]. nOn~e lbslfons/vr 2. / Ibs/Tonskr 3. / lbs/Tonshz <br />4. / lbs/Toas/vr 5. / lbsll'ons/vr <br />5.2 Anticipa[edenduseofprimarycommoditie(s)tobemined: construction materials <br />Anticipated end use of incidental commodiie(s) to be mined: <br /> <br />