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M-2c~o4--a3~ <br />STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman 5[., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 86fr3567 CONSTRUCTION MATERIALS <br />F'~t(~(30~~~~ LIMITED IMPACT(I10)OPERATION RECEIVED <br />fOR SCANN/NG /~CLAMATION PERMIT APPLICATION FORM/MAY 2 42004 <br />COLORADO <br />DIVISION O F <br />MIN &RALS <br />GEOLOGY <br />RECLAMATION•M INING <br />SAiETY•SCIENCE <br />Bill Owens <br />Gavemor <br />Division of Minerals and Deolagr Greg E. Walther <br />CHECK ONE: There is a File Number Already Assigned to tbis Operation Executive Director <br />Permit # M -_ _ _ (Please reference the file ntunber cturently assigned to this operation) Ronald w. cottony <br />Division DirMOr <br />X New Application (Rule 1.4.5) Amendment Application (Rule 1.10) Natural Resource Trustee <br />Conversion Application (Rule 1.11) <br />Permit # M -_ -_ (provide for Amendments and Conversions of existing permits) <br />The application for a Construction Materials Limited Impact (I 10) Operation Reclamation Permit amtains throe majorparts: (1) the application <br />forzn; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability Exhibit, as required by the Office, and <br />outlined in Rules 6.1, 6.2, 6.3, 6.5, and 1.6.2(1)(6); and (3) the application foe. When you submit your application, be stue to include one <br />(I) wmplete siRrted and notarized IYORY ORIGINAL and one (I) wpy of the completed Ivory application form, two (2) copies of Exhibits <br />A-J, Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as required, and a check for the application fee <br />described under (4) below. Exhibits should ~2T be bound or in a 3-ring binder; maps should be folded to 8 l!2" X 11" or 8 I /2" X 14" size. <br />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 apace provided, ALL information descr)'bed below. <br />1. AoolicanUoceratororrnmoanvname(nametobeusedonoertnifl:Rio Blanco County Road & Bridge <br />1.1 Type of organization (corporation,parmership,etc.): County Government <br />1.2 1.2 I.R.S. Tax ID No. or Social Security Number: <br />2. Operation name(oit.mineoraRenamel: West Johnson Draw <br />3. Permitted aceaee (new or eaiatin¢ sitel: 9 . 9 9 permitted acres <br />3. I Change in acreage (+) acres <br />3.2 Total Acreage m Permit Area 9 . 9 9 acres <br />4. Fees: <br />4.1 New Application: $1.094.00 application fee <br />Amendment Fee(C.R.S.34-32.5-12~(II)): 719.00 application fee <br />4.2 Conversion Fee (from 1 lOd to 110 $875.00 conversion fee (Bute 1.11.2(2)) <br />5. Primary commoditie(sl to be mined: Grave 1 <br />5.1 Incidental commoditie(s) to be mined: 1. / Ibs/TonshT 2. / lbs/fonsPor 3. / 1bsfl'onshT <br />4. / Ibs/fons/vr ~. / ]bs/TonshT <br />5.2 Anticipated end use of primary'commoditie(s)to 6e mined: Road SUrfaCi <br />Anticipated end use of incidental commoditie(s) to he mined: <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Survey <br />