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STATE OF CO~~?~ DO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources ~`~e <br />~ <br />' <br /> /r/B~ <br />9 <br />~a~ <br />~ <br />1313 Sherman St, Room 215 <br />Denveq Colorado 80203 <br /> <br />CONSTRUCTION MATERIAL~~LE a/ <br />6/4 <br />COP ej ep+ C O L O RA D O <br />DIVISION O F <br />M I N <br />RA L S <br />Phone: (303) 86(.3567 <br />FAx: (303) 832$t 06 REGULAR (112) OPERATION~~ Co <br />SCANN/N S <br />G E O L O G Y <br />RECLA MATION PERMIT APPLICATI RE CLAN ATION•N INING <br />EAFETT•ECIENCE <br />alit Owen$ <br />CHECK ONE: There is a File Number Already AasigrEed to this Operation cO"0"1Of <br />Greg E. Walther <br />Permit # Irv -_-_ _ (Please reference the file nlmmbet cEnrently assigned to this operation) E;~,nire DirecTOr <br />_ New Application (Rule 1.4.5) /Amendment Application (Rule 1.10) Ronan w. Caaany <br />Conversion Application (Rule 1.11) Division Director <br />Natural Resource Trustee <br />Permit # M -1~-~ - f~'~(provide for Amendments and Conversans of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains throe major parts: (1) the application form; <br />(2) Exhibits A-S, Atldendtnn 1, airy sections of Exhibit 6.5 (Geoteclmical Stability Exhibit; and (3) the application fee. When you submityow <br />application, be st¢e to include one (1) complete sued and notarized IVORY ORIGINAL and arse (1) txpy oftlte complied I~ applicators <br />form, two (2) copies ofExiibits A-S, Addendtmm 1, appropriate sections of 6.5 (Geotechnical Stability Exhibit, and a check for the application <br />fee described tinder Section (4) below. Exhibits should NOT be bound ar in a 3-ring binder, maps should be folded to 812" X 11"or 812" X <br />14" size. To expedite processing, please provide file information in the fanner and order described in tlis form. <br />GEN17tAL OPERATION INFORMATION <br />Type or print ekarty, in the space provided, ALL inf~ol ~mation requestepd belmr. n <br />1. Aoolicantfonerator or eomoanv name !name to he used on cermitl: ~QJ ~u QQB,~ Ji}n!a ~ (MA ~ ~~ .T.~~, <br />1.1 Type of organizaton (corparatan, partnership, etc.): s t~EYL~ <br />1.2 I.RS. Tax I.D. No. or Social Security Number: P5°- //L .r//feS <br />2. Operation Dame (ott. mine or site name): G.~®~iA Z <br />3. Permitted acreage (new or elristine 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 Quarry Application <br />4.4 Amendment Fee <br />4.5 Conversion to 112 operation (set by stattie) <br />5. Primary commoditie(s) to be mined: <br />5.1 Incidental commoditie(s) to be mined: 1. - Ibs/fonslvr <br />3. / Ibs/Tons/vr 4. / Ibs/fonshT <br />5.2 Anticipated end.trse of primary commoditie(s) to be mined: <br />5.3 Anticipated end use of incidental commodite(s) to be mined: <br />/~ permitted acres <br />/~. H'J acres <br />~©. y,Z acres <br />$2.344.00 application fee <br />$2.906.00 quarry application <br />$1938.00 amendmentfce <br />$2.344.00 conversion fee <br />2. ! ]bs/TonshT <br />5. 1 Ibs/Tons/vr <br />~Ge ~ Office of Colorado <br />Mined Land Reclamation ~ Active and Inactive Mines Geological Survey <br />