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<br />DIVISION OF MINERALS AND GEOLOGY <br />Dep,mmem of Ndhval Resources <br />I; I S iherman SL, Roum ' I i <br />Denver. Colorado 8020} <br />Phune 1:1111 86 6-3 5 6 7 <br />FAX' l10 SI H}~-8106 <br />iii riiiiiiuiu iii <br /> <br />/~f,-f- ~o~s <br />~/,sso•oo <br />OF COLORADO <br />FiECFIV~= <br />f= ~ g 2 Q 2000 <br />~~ <br />DI `/I S ION OF <br />MINEftALS~ <br />GEOLOGYI <br />REC LA MATIONI <br />MINING•SA FETY ~ <br />CONSTRUCTION MATERIAL pivis+un of minerals 8 ~~a9Y <br />REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />Bill Owens <br />Gn.ernor <br />Gret; E Watcher <br />Execmive Director <br />CHECK ONE: New A lication Rule 1.4.5 Amendment A lication Rule 1.10ppS'chael B. Long <br />PP ( ) ~_ PP ( b,~~:ion Director <br />Conversion Application (Rule 1.1 I ) <br />Permit # M - 88 - 048 -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (I) the applicarion form; <br />(2) Exhibits A-S, Addendum I, atry sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sieved and notarized IVORY ORIGINAL and four (4) copies of the completed Ivory <br />application form, five (5) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geotechniral Stability Exhibit, and a check for <br />the application fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to <br />8 I/2" X l l" or 8 I/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, io the space provided, ALL informatioa requested below. <br />I. ADOlicaobooerator or comoaav name (acme to be used oapermit): Andes; ra Rnrk (lnmha n~ <br />l .l Type of organvation (corporation, partnership, etc.): ~ n rRnra r; nn <br />1.2 I.R.S. Tax [.D. No. or Social Security Number: <br />2. Operation name (pit, mice or site camel: <br />3. Permitted acreaee f mew or existine site): <br />3.l Change in acreage (+) <br />3.2 Total acreage in Permit area <br />Carr Gravel Resource <br />4. Fees: <br />4,1 New Application <br />4,2 New Quarry Application <br />4.3 Milling Application (Non-DMO) <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by statute) <br />5. Primary commoditie(s) to be mined: sand eravel <br />5.1 Incidental commoditie(s) to be mined: 1. n/a - Ibs/fons/vr <br />3. / Ibs(fonslvr 4. / Ibsff ohs/yr <br />1302 permitted acres <br />1 d f` acres <br />14 t 2 acres <br />$1.875.00 application fee <br />52.325.00 quarry application <br />$3.100.00 milling application <br />$1.550.00 amendment fee <br />$1.875.00 conversion fee <br />2. / Ibs/Tonslvr <br />5. I IbslSonslvr <br />5.2 Anticipated end use of primary commoditie(s)tobemined: asphalt/concrete <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: n /a <br />