PERMFILE116470

• Permit No: M2004009
• IBM Index Class Name: Permit File
• Doc Date: 2/17/2004
• Doc Name: Proof of Filing with the County Clerk
• From: DMG
• To: Asphalt Specialties Co Inc
• Section_Exhibit Name: Exh. R
• Media Type: D
• Archive: No

DIVISION OE MINERALS AND GEOLOGY
Department of Natural Resources
1373 Sherman St., Room 275
Denver, Colorado 80203
Phone: [phone]
FAX: [phone]
FEB 17 2004 ~/
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OF COLORADO
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RECLAMATION
MIN It.G•SAFET7
@Ivision d Minerals and Geology
CONSTRUCTION MATERIALS
REGULAR (112) OPERATION
RECLAMATION PERbIIT APPLICATION FORM
Bill Owens
Governor
Greg E. Walther
Executive Director
`r~CK ONE: R New Application (Rule 1.4.5) _ Amendment Application (Rule 1.1 ichaet S. Long
[/ivision Director
Conversion Application (Rule 1.11)
Permit # M -_ -_ (provide for Amendments and Conversions of existing permits)
Te anplica[ion for a Consmtction Ivlaterials Regular 112 Operation Reclamation Peanit contains three major pazcs: (1) the application form;
) Exhibits A-S, Addendum 1, any secfions of Exhibit 6.5 (Geotechnical StabilityExhibit; and (3) the application fee. When you submit your
plicatlon, be stue to include one (1) comolete sicned and notazized IVORY ORIGINAL and four (4) copies of the completed I~
tolication farm, five (5) copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Oeotechnical Stabilitylxhibit, and a check for the
,plicafion fee described under Secfion (4) below. Exhibits should NOT be bound az in a 3-ring binder; maps should be folded to 8 1/2" X 11"
8 1/2" X 14" size. To expedite processing, please provide the information in the format and order described in this form.
GENERAL OPERATION INFORMATION
Type or print clearly, in the space provided, ALL information requested below.
AnDlicant/ooerator or comoanv name (name to be used on Hermit):
Asphalt Specialties Co., Inc
1.1 Type of organization (corporation,paztnership,etc.): CorRoration
1.2 I.R.S. Tax I.D. No. or Social Sectaity Number:
OHerationname(Hit,mineorsitename): Turnnike Min;n~Racnr,rr•e
Permitted acrease (new or existine site): 9 7 Lli- permitted acres
3.1 Change in acreage (+)
3.2 Total acreage in Perini[ azea
Fees:
4.1 New Application
4.2 New Quarry Application
4.4 Amendment Fee
4.5 Conversion to 112 operation (set by statute)
Primary commoditie(s) to be mined: Sand Gravel
5.1 Incidental commoditie(s) to be mined: 1. lbsffons/vr
acres
acres
$2.344.00 application fee
$2.906.00 quarry applicaacn
$1.938.00 amendmen[fee
$2.344 00 conversion fee
2. / lbs/I'ons/vr
3. / lbs/I'ons/vr 4. / lbs.?ons/vr 5. / lbs/I'ans/vr
5.2 Anticipated end use of primary commoditie(s)to be mined: Construction/ Ccrte.Ete~A5p M l1=

5.3 Anticipated end use of incidental commoditie(s) to be mined: None