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/~9-aod~ - os 3 .~ <br />RECEIVED <br />JUN 0 9 2006 ~ <br />MATERIALS / Division ~I Minerals and Geafo~y <br />LIMITED IMPACT (110) OPERATION <br />RECLAMATION PERMIT APPLICATION FORM <br />CHECK ONE: There is a File Number Already Assigned to this Operation <br />Permit # M -_ _ _ (Please reference the file number currertdy assigned to this operation) <br />X New Application (Rule 1.4.5) Amendment Application {Rule L 10) <br />Conversion Application (Rule 1.11) <br />Permit # M - _ (provide for Amendments and Conversions of existing peaniLS) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit contains three major parts: (I) the <br />application form; (2) Exhibits A-J, Exhibit L, Addendum 1, any sections of Exhibit 6.5 and Geotechnical Stability E.vhibit, as required <br />by the Office, and outlined in Rules 6.1,6.2,6.3,6.5,and1.62(lXb);and(3)theapplicationfee. When yousubmityourapptication,be <br />sure to include one (1) complete signed andnotarized ORIGINAL and one (I) copy of the completed application form, two (2) copies <br />of Exhibits A-J, Exhibit L, Addetdum i, and appropriate secfiotts of 6.5 (Geotechnical Stability Exhibit), as negiuted, and a chock for <br />the application fee described under (4) below. Exhibits should NOT be bound or in a 3-ring binder; maps should be folded to 8 l/2" X <br />11" or 8 1/2" X ] 4" size. To expedite processing, please provide the information in the format and order described in this form, <br />GENERAi., OPERATION INFORMATION <br />Type or print clearly, in the space provided, ALL information described below. <br />1. Ann licant/ooerator or company name (name to be used on permit): a n y o n Rim S t_ O T1 P T T f <br /> 1.1 Type of organization (corporation, partnership, etc.): Limited L i a b i l i t y C o m p a n y <br />2. Operation name(nit-mioeor sitenamel: Canyon Rim Stone Ouarry <br />3. Permitted acreage (new or existing site): 9 . 8 8 permitted acres <br /> 3.1 Change in acreage (+) acres <br /> 3.2 Total Acreage in Petmit Area 9 • $ $ acres <br />4. Fees : <br /> 4.1 New Application: $1.094.00 application fee <br /> Amendment Fee (C.RS. 3432.5-125(II)): $719.00 application fee <br /> 4.2 Conversion Fee (from 1 IOd to 110 $875.00 conversion fee (Rule L 11.2(2)) <br />5. Primary commoditie(s) to be mined: h n i l A j, n~ s t n n a a n A l a n d < r a p i n_T <br /> 5.1 Incidental commoditie(s) to be mined: 1. / Ibs/Tons/yr 2. / Ibsffons/vr 3. / Ibs/Tons/vr <br /> 4. / Ibs/Cons/vr 5. / Ibs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: b u i l d i n g b u i l d i n,~ , l a n d s n a ; n y, <br />Anticipated end use of incidental commoditie(s) to be mined: <br /> <br />