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TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of NaturaV Resources <br />1313 Sherman St., Room 275 <br />Denver, Colorado 80203 <br />Phone: (3D3) 8b6-3567 <br />FAX: (303) 832-8706 <br />RECEt~<E~ <br />F~c~ I r ;,"Q7 <br />DIVISION O F <br />MINERALS <br />GEOLOGY <br />RECLAMATION <br />MI NING•SAFETY <br />Division of Minerals and Geology <br />CONSTRUCTION MATERIALS RECEIVED <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICA~TON FORMFEB 1 ~ ZOOZ <br />CHECK ONE: ~ New Application (Rule 1.4) <br />Bill Owens <br />Governor <br />Greg E. Walther <br />BiYi9i0d st Minerals and GeafogyExe~~r,ve Olrector <br />~M[1~ivcyhsyael B. Long <br />Conversion Applicaton (Rule 1.11)on Director <br />Amendment Applic~flon (C.R.S. 34-32.5-110) <br />Permit # M -abo ~4-^/ (provide for Amendments and Conversions of exisfing permits) <br />The application far a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major pazts: (1) the application form; <br />(2) Exhibits A-J, Exhibit L, Addendum 1, any secflons of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and outlined in Rules <br />6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(b); and (3) the applicaflon fee. When you submit your application, be sure to include one (1) complete signed and <br />notarized IVORY ORIGINAL and one (1) copy of the completed Ivorv application form, two (2) copies of Exhibits A-J, Exhibit iw Addendum 1, and <br />appropriate sections of 6.5 (Geotechnical StabilityExhibit), as required, and a check for the applicafion fee described under (4) below. Exhibits should <br />NOT be bound or in a 3-ring Mnder; maps should be folded to 8 112" X 11" or 8 172" X 14" size. To expediteprocessing,p)easeprovide the information <br />in the forma[ and order described in this form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />Aoalicant/ouerator or comoany name (name to be used on permit): SRO E/NS ~DNST.P_UGT/O/~/ C. L LLP <br />1.1 Type of organization (corporation, paztnership, etc.): L L L P <br />1.2 I.R.S. Tax ID No. or Social Security Number: ~4 - / y S rJ o~ 7 ~ <br />Operation name (pit, mine or site name): V RO L~3/ Nr5 /-/ T NB . <br />Permitted acreaee (new or existine site): • 8 ermined acres <br />3.1 Change in acreage (+) acres <br />Total Acreage in Perini[ Area acres <br />Fees: <br />4.1 New Application: 1 094.00 application fee <br />Amendment Fee (C.R.S. 34-32.5-125(II)): 719.00 application fee <br />4.2 Conversion Fee (from 110d to 110 875.00 conversion fee (Rule 1.11.2(2)) <br />Primary commoditie(s) to be mined: AVEL <br />5.1 Incidental commoditie(s) to be mined: 1. / lbs/fons/vr 2. / lbs/Tons/vr 3. / lbs/Tons/vr <br />4. / Ibsll'ons/vr 5. / lbs/Tons/Kr <br />5.2 Anticipated end use of primary commoditie(s) to be mined: se0/1 /~ CONST.t~ UG T / O N ////~ TE,2/AL <br />5.3 Anticipated end use of incidental commoditie(s) to be mined: <br />