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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY ~ RGC~~\/CD <br />Department of Natural Resources V C <br />1313 Sherman St., Room 215 FEB 2 4 2004 r/ C O LO RA D O <br />Denver, COIOradD 80203 D[ Y I S 1 0 N O F <br />Phon ) G• CONSTRUCTION MATERIALS MINERAL $ <br />FAx: t PY REGULAR (112) OPERATION Division of Minerals and Geology G E O L O G Y <br />®/R ~ /v /o A jA/'~f.AMATION PERMI'T' APPLICATION FORM R EC LANATION• MIN I N G <br />!/I( /V_A(-®~'Y,Y ,!!YC/'~a' SAFETY •SCIFNCE <br />CHECK ONE: Yesr There is a Flk Nimtber Already Assigned to this Operstbn <br />aiii Owens <br />Governor <br />Permit # M -_ i _ (Please reference the file number eurrentl assi ed to this eration Creg E. Watcher <br />Y !in oP ) Executive Dirxtor <br />New' Application (Rule 1.4.5) / Amendment Application (Rule 1.10) Ronald w, caaany <br />bivision Director <br />Convenion Application (Rule 1.11) Natural Resource Trustee <br />Permit # M _ 19 ~ 9 _ 195 '~ (provide fa Amendments and Conversions of existing permits) <br />The application for a Construction Materials Regular 112 Operation Reclamation Permit contains three major parts: (1) the application form; <br />(2)E.xhibitsA-S,Addendmnl,anysectionsofExhibit6.5(GeoteclmicelStabilityExhibitand(3)theapplicationfee. Whenyousubmityour <br />application, be sure to include one (1) complete simted and rtotarized IVORY ORIGINAL and one (1) copyofthe completed ~ application <br />form, two (2) copies ofExhibits A-S, Addendum 1, appropriate sections of 6.5 (Cs~techaical Stability Exhibit, and a check for the application <br />fee described under Section (4) below. Exhibits should NOS be bound ar in a 3-ring binder, maps should be folded to 81/Z" X 11"or 8112"X <br />14" size. To expedite processing, please provide tbe information m the fomrat and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, io the space provided, AL information requested bebw. <br />1. AnotlcanUoocrator or comoaov name (name to be used on permit): Suburban Sand and Gravel Co .'~ <br />1.1 Typeoforgeaization(corpwation,parinership,etc.): Corporation <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: <br />2. Ooerationname(oil"mfoeorsitenamel: Road Runners Rest II Pit <br />3. Permitted urea¢e (nerv or eristing site): 168 .41 permitted acres <br />3.1 Change in acreage (+) acres <br />3.2 Total acreage in Pertr»i area 168.41 acres <br />4. Fees: <br />4.1 New Application $33 q+t 8tt_t~piieatioa_fee <br />4.2 New Quany Application o <br />)E4.4 Amendment Fee $1.938.00 amendment fee <br />4.5 Conversion to 112 operation (set by statute) <br />>. Ptimarv rnmmoditk(s) to be mined: <br />gravel <br />5, ] Incidental commoditie(s) to be mined: 1. - Ibs/1'ons/vr <br />3. / lbs/fons/vr 4. / Ibs/Cons/vr <br />5.2 <br />2. / Ibsffons/vr <br />5. / lbs/fons/yr <br />Anticipated end use of primary cotnmoditie(s)tobemined: Construction materials <br />5.3 Anticipated end use of incidrntal commoditie(s) to be mined: <br />Office of Office of Colorado <br />Mined land Reclamation ~ Attive and Inactive Mines Geological Survey <br />