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~ i <br />-~-a;,~ <br />CONSTRUCTION MATERIALS <br />REGULAR(ri2)OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />f~OU t, ;; 2C04 <br />~~i!'ioion of ?9inerala g GsalalgV <br />CHECK ONG: There is a File Number Already Assigned to [his Operation <br />Permit # M -_ _ (Plense reference thefle number currently assigned to this operation) <br />New Application (Rule 1.4.5) % Amendment Application (Rule I.10) <br />Conversion Application (Rule I.I l) <br />Permit # M -2QQQ~11.6 _-_ (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 application <br />form; (2) Exhibits A-$ Addendum I, any sections of Exhibit 6.5 (Geotechnical Stability Exhibit; and (3) the application fee. When you <br />submit your application, be sure to include one (I) complete signed and notarized ORIGINAL and one (I) copy of the completed <br />application form, two (2) copies of Exhibits A-S, Addendum 1, appropriate sections of 65 (Geoteehnical 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 11" or R 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 requested below. <br />Applicant/operator or company name (name to be used on permit): Lafarge West, Inc. <br />1.1 Type of organization (corporation, partnership, e[c.): Corporation <br />1.2 LR.S. Tax LD. No. or Social Security Number: <br />2. <br />3. <br />Operation name fait, mine or si[e name): Riverbeitd Operation <br />Permitted acreage (new or existini? site): <br />3. I Change in acreage (+) <br />3.2 l'otal 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 statute) <br />5. Primary commoditie(s) to be mined: Sand Gravel Fill <br />5. i Incidental commoditie(s) to be mined: 1. NA - Ibs/"i'ons/vr <br />437 permitted acres <br />931 acres <br />1 ~'2 F,R acres <br />$2.344.00 application fee <br />$2,906.00 quarry application <br />$7.938.00 amendment fee <br />$2,344.00 conversion fee <br />2. / Ibs/Tonsh~r <br />3. / Ibs/Tons/vr 4. / Ibs/Tons/vr 5. / Ibs/'I'ons/yr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: Construction Materials <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: NA <br />