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ILE <br />OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY /"VIi JliH/Y/Y//Y~ /~EG+E'VED <br />Department of Natural Resources <br />1313 Sherman SL, Room 21 i _ /I~AY ~ n <br />Denver, Colorado 80203 ~ ~~~II / J ~~'1 <br />Phone: (303) 866-3567 CONSTRUCTION MATERIALS <br />FAX: (303) 832-8106 REGULAR (112) OPERATION ~ 0lrision of Minerals and GeBI <br />RECLAMATION PERMIT APPLICATION FORM <br />DIVISION O <br />MINERAL <br />GEOLOGY <br />rR EC LAMATION <br />MI NING•SAFETY <br />Bill Owens <br />Governor <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Greg E. Walther <br />Permit # M -; _ _ (Please reference the file number currentty assigned [o Ibis operation) Executive Director <br />New Application (Rule 1.4.5) <br />Michael B. Long <br />x Amendment Application (Rule I.10) Division Director <br />Conversion Application (Rtlje 1.11) <br />Permit # M - I aRO-O25 - ,/_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Qperation Reclamation Permit contains three major parLS: (1) the application form; <br />(2) Exhibits A-S, Addendlmm 1, any sections of Exhibit 6.5 (Geoteclntical Stability Exhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sired and notarized IVORY ORIGINAL and four (4) copies of the completed No <br />application form, Sve (5) copies of Exhibits A-S, Addendum I, appropriate sections of 6.5 (Geotechnical 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 1/2" X 1 I" 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 clearly, in the space provided, all information described below. <br />' 1. AooGcant/ooerator or comuanv name (name to be used o0 oermitl: <br />Faun S~--a#~es Anc~rec~a.°~'ers , LLC <br />1.1 Type of organization (corporation, partnership, etc.): L{ t~ L 5 2,d - ~.Yd ~ 1, ~ L~ ~J Y1'I (33Y1t,1 <br />1.2 I.RS. Tax I.D. No. or Social Security Number: ~j <br />2. Operation name (nit, mine or site name): ~-~au ~mp 1 l <br />3. Permitted acrease (new or eaistins' sitel: aS •~~ permitted acres <br />3.1 Change in acreage (+) 1 .~Z acres <br />3.2 Total acreage in Permit area 4~O ; OO acres <br />4. Fees <br />4.1 New Application $2.344.00 application fee <br />4.2 New Quarry Application $2,906.00 quarry application <br />4.4 Amendment Fee '~ $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) $2,344.00 conversion fee <br />5. Prim ary commoditie(sl to be mined: end I'c~ V <br />5.1 Incidental commoditie(s) to be mined: 1. / lbslTons/v r 2. / lbs/Tons/vr 3. / lbs/Tons/~r <br /> 4. / lbslTons/v r 5. / lbs/Tons/vr <br />5.2 Anticipated end use of primary commoditie(s) [o be mined: CO n S'IY'VC-t~ 0 Yl <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />