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<br />STATE OF COLO O <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />137 3 Sherman St., Room 27 5 RECEIVE ~ <br />Denver, Colorado 80203 CONSTRUCTION MATERIALS <br />Phone: (3031866-3567 AUG 7 9 2004 <br />EAx; t3o3) E32-8706 r~ REGULAR (112) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM Division of Minerals & Geo <br />CIiECK ONE: x There is a File Number Already Assigned to this Operation <br />Pettnit # _Iv - 3•~3 - 0 3 __ (Please reference the file~n/umber currently assigned [o this operation) <br />_ New Application (Rule 1.4.5) !~ Amendrgent Application (Rule 1.10) <br />_ Conversion Application (Rule I. I I) L/ <br />Permit # M -x003 - 03l -_ (provide for Amendments and Conversions of existing penni[s) <br />COLORADO <br />DIVISION O F <br />MINE~LRALS <br />GEOLOGY <br />I~CLANATION•NINING <br />SAFETY•SCIFNCE <br />Bill Owens <br />Governor <br />Greg E. Walther <br />Executive Director <br />Ronald W. Cattany <br />Division Direcor <br />Natural Resource Trustee <br />The application for a Construction Materials Regulaz 112 Operation Reclamation Perarit contains three major parts: (1) the application form; <br />(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geotechnical Stability F,xhibit; and (3) the application fee. When you submit your <br />application, be sure to include one (1) complete sit3ted and notarized IVORY ORIGINAL and one (1) copy of the completed IVON application <br />form, two (2) copies ofExhibits A-S, Addendum 1, appropriate sections of6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee described under Section (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be Colded to 81 /2" X I l" or 8112" X <br />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 requested bebw. ~ _ J / <br />1. AoolicanUooerator or rnmoanv name (name to be used on cermip: Flgldoc'SO n Amy So nS ~~G / <br />1.1 Type of organization (corporation, partnership, etc.): Cor~rg~'i o n <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: g ~ ' ~ ~ ~ O 913 <br />2. ODerationnametnit.mineorsRename): Na~dorSOn hand and G~ave~ Mit\(r_ <br />3. Permitted aceage (new or esistin¢ site): <br />3.1 Change in acreage (+) <br />3.2 Total acreage in Permit area <br />4. Fees: <br />4.1 New Application <br />4.2 New Quarr}° Application <br />4.4 Amendment Fee <br />45 Conversion to 112 operation (set by statute) <br />5. Priman' commoditie(s) to be mined: S~qt,~_ V r v <br />~.1 Incidental wmmoditie(s) Yo be mined: 1. - IbslTons{vr <br />1.5G.0 permiuedacres <br />~' 4 ~ a-] acres <br />I~O,a"1 acres <br />$2 344.00 application fee <br />$2.906.00 quam' application <br />$1.938.00 amendment fee <br />$2.344.00 conversion fee <br />2. / ]bs/Tonshr <br />3. / Ibs/Tons/vr 4. / Ibps/Ton1s/trp i. / lbs/TonshT <br />5.2 Anticipated end use of primary commoditie(s) to be muted: ^ Ogtl 6a S2 Q nd Ca n S)- r u f-I-~o n <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: NO tt~ <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Su <br />