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. <br />.:. . <br />. -.~.+.9iva~ rvnu ~ ~~ P\ 1 1Z~~v~ <br />CHHCK ONfi: ~ New Application (Rule 1.4.5) Amendment Application (Rule 1.10) 1 <br />_ Conversion Application (Rule 1.11) <br />Permit # M (provide for amendments and conversions of existing <br />permits) <br />The application for a Regular Operation Reclamation Permit contains three major parts: (1) <br />the application form; (2) Exhibits A-S and Geotechnical Stability Exhibit; and, (3) the <br />application fee. When you submit your application, be sure to include one (1) signed and <br />notarized original and four (4) capiee of the application form, five (5) copies of Hxhibits <br />A-R and any required sections of Exhibit S and the Geotechnical Stability 8xhibit, aad a <br />check for the application fee described under Section (16) on Page 3. Exhibits should not <br />be bound or in a 3-ring biader; maps should be folded to 8 1/2" X il" or 8 1/2" X 14" size. <br />To expedite processing, please provide the informatioa in the format and order described in <br />this form. <br />GSNHRAL OPHRATION INFORMATION <br />Type or print clearly, in the space provided, all information described below. <br />--------------------------------------------------------------------------------------------- <br />--------------------------------------------------------------------------------------------- <br />1. Ap scant/opera or o company name (name to be used on permit): <br />11011LL~/Q ~ ~ ~G ;'rlP r <br />1.1 Type of organization (corporation, partaerehip, etc.) : .5OI'e f> r0OlP'O(S~'li o <br />1.2 I.R.S. Tax I.D. No. or Social Security Number: S.~a ~Ua• ` 7~ )~• <br />2. Operation name (pit, mine or site name) : PE'GL~ )YJ ~ (1 <br />3. Permitted acreage (new or existing site) ~ ~ ' pemtitted acres <br />3.1 Change in acreage (+ or -.) (amendment or conversion) accx~ <br />3.2 Total acreage is Permit area acres <br />4. Fees: <br /> 4.1 New Application 51.875.00 application fee <br /> 4.2 New Quarry Application S2 .325.00 quarry application <br /> 4.3 Milling Application (Non-DMO) 53. 100.00 milling application <br /> 4.4 Amen~ent Fee 51.550.00_ amendment fee <br /> 4.5 Conversion to 112 operation (set by statute) 51.500.00 conversion fee <br />5. Primary commoditie(s) to be mined: ~Q+ GC Y /~ <br /> <br />6. <br />Name <br />of owner of subsurface rights of affected land: -~pp r7 <br />o~Q. y C7c ~- • L7G.1~Y7P~ <br /> If 2 or more owners, refer to Hxhibit O. <br /> <br />7. <br />Name <br />of owner of surface of affected land: ~OY)Le ~ /~~"" <br />L~ t..CA fYCe f <br /> <br />B. Type of mining operation: ~ Surface IInderground <br />9. Location Information: the center of the area where the majority of mining will occur <br />lies in: /~'Q~O~, <br />CODNTY: Ft ~ <br />PRINCIPAL MERIDIAN (check one): 6th (Colorado) / 10th (New Mexico) ~ IICe <br />SECTION (write number) : - S ~ <br />TOWNSHIP (write number and check direction): T ~ -/NOrth _ South <br />RANGH (write number and check direction): R ~ Saet _ West <br />QDARTHR SBCTION (check one): _ NH _~NW _ SE _ SW <br />Ql'AIRTHR/Q~RTHR SECTION (check one) : NH NW SS SW <br />GHNBRAL DESCRIPTION (miles and direction from nearest town and approximate ~evation): <br />~~Qn7d~Cc- !! m,~(es C~Q~~' a-F /Q~Ct~rycp A <br />75 AS -Fa~o~ ccF»v,a Y»enn man l,o~,,o.l <br />.e::.:.. <br />_. <br />-- '- - - <br />- _ -_ -. .. _ -~ - -.:..-=.a%~`+=u~?c:+- . _. -- .. r fir .. <br />