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P.' <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832$106 <br />CONSTRUCTION MATERIALS <br />REGULAR (112) OPERATION <br /> <br />C~'I ~ ~l 2005 <br />RECLAMATION PERMIT APPLICATION FORM ~ <br />CHECK ONE: ti`' There V a Fik Number Already Assigned to thin Operation <br />Permit # M - 92 -~- ~ (Please reference the file number currently assigned to this operation) <br />_ New Application (Rule 1.4.5) ^ Amendment Application (Rule 1.10) <br />Conversion Application (Rule 1.11) <br />COLORADO <br />DIVISION O F <br />M[N~RALS <br />GEOLOGY <br />AEGEAN ATIOM NI NINO <br />SAf ETY•s CIFNC! <br />Permit # Zvi _- ~ 2 - ~ -_ (provide for Amendments and Conveniona of Blasting permits) <br />all) Owenf <br />GOVIIIKK <br />Russell George <br />Executive Director <br />Ronald W. catw,y <br />Division Direttd <br />Natural Resource Trustee <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major pans: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections ofExhibit 6.5 (Geotechnical Stability Exhlbit; and (3) [he application fee. When you submityota <br />application, be sure to include oce (1) complete sited azld notarized ORIGINAL and one (1) copy of the completed applicationfonrl,lwo (2) <br />copies of Exlubits A-S, Addendum 1, appropriate sxtions of 6.5 (Geotechnical Stability Exhibit, end a check for the application fee described <br />under Section (4) below. Exhibits should ~iOT be bound or in a 3-ring binder, maps should be folded to 8 1 /Z" X 11 " or 8112' X 14" size. To <br />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 Imformatlop requested below. <br />1. App licant/ocerator or rnmpanvname (name to be need on permk): L B GQ L.(,G <br /> ].] Type of organization (corporation,partnerslup,etc.): Liml~e~ Liabili~-y Corv ~an.! <br />2. Ope ration same (pk. mine or site name): ~ ~I 1'13 G 1 O ~ 1 ~' <br />3. Per mitted acreage (new or existing site): °1 • `~ permitted acres <br /> 3.1 Change in acreage (+) S Q , ~ acres <br /> 3.2 Total acreage in Permit area g0 acr>~ <br />4. ~: <br /> 4.1 New Application X2344 00 application fee <br /> 4.2 New t~uarry 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. Primary rnrnmodide(s) to be mined: S 2r ~ j !~ ~~!e <br /> 5.1 Incidrntal commoditie(s) to be mined: 1. Ibs/Toas/vr 2. / lbs/1'tms/vr <br /> 3. / Ibs/1'ons/vr 4. / Ibs/fons/vr 5. / Ibs/fonshlr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: <br /> 5.3 Anticipated end use of incidental commoditie(s) to Ix mined: <br /> Office of Office of Colorado <br /> Mined Land Reclamation Artive and Inactive Mines re..l^^:-,I c. •-.-. <br />