PERMFILE124449

• Permit No: M2005059
• IBM Index Class Name: Permit File
• Doc Date: 8/1/2005
• Doc Name: 112 Permit Application Form
• From: asphalt specialties co inc
• To: dmg
• Media Type: D
• Archive: No

.~,~_ Apo s'-DS`5'
STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Department of Natural Resources ~I~c~`E/~~
1313 Sherman it., Room 21 i - Y C ~ L ~ 1ZAD ~
Denver, Colorado 60203 / f`,U!? D ~ MINERAL S
Phone: [phone] ~ /y~/ONSTRUCTION.LIATERIAI:.~ U Z~~J &
FAX: [phone] (/ I2Fi GULAR 112) OPERATION ~~ ~F,.~ Ci 1:. ~ I ~ Ci Y
( 1/f 9~st(Ia el r~jtae7~$~ FCIAM ATION•M INING
RECLAMATION PERMIT APPLICATION FORM :Are Tr • s n F N c F
Bill Owens
Governor
CHECK ONE: ~_ There is a File Number Already Assigned to tbis Operation
Russell George
Petmit # _ _ _ (Please reference the file number currently assigned to Iles operation) E.e<utive Director
Ronald W. Caaany
~ New Application (Rule 1.4.5) _ Amendment Application (Rule 1.10) Division Director
Natural Resource Trustee
Conversion Application (Rule 1.11)
Permit # M -~ -_ (provide for Amendments and Conversions of existing permits)
The application for a Construction Materials Regular 112 Operation Rec]amation Pemit contains three major parts: (1) the application form;
(2) Exhibits A-S, Addendum 1, any sections of Exhibit 6.5 (Geoteclinical Stability Exhibit; and (3) the applicarion fee. When you submit your
application, be sure to include one (I) complete sinned and notarized ORIGINAL and one (1) copy of the completed applicafionform,rwo (2)
copies of Exhibits A-S, Addendum 1, appropriate sections of 6.5 (Geotedhnical Stability Exhibit, and a check for the application fee described
under Section (4) below. Exhibits should NOT be bound or in s 3-ring binder; maps should be folded to 8 1/2" X I 1 " or 81/2"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. ~ .j'~ jyl
Anolicant/ouerator or comnanvname (Dame to be used o~nsn~ermitl: ~phnl~ JC~L10~7JEJ ~[J•. Z/1L.
1.1 Type of organization (corporation, partnership, etc.): C.Ct'Gbr'6'~LOYI
r . s1 r r
2. ODeratioa name fait. mice or site name):
3. Permitted acreage (new or eaistlnc site):
3.1 Change in acreage (+)
3.2 Total aaeage in Permit azea
4. Fees:
New Application
2 New Quarry Application
4.4 Amendment Fee
4.5 Conversion to 112 operation (set by statute)
5. primary commoditie(s) to be mined: SAY7[J Qe~
5.1 Incidental commoditie(s) to be mined: 1. u I A - Ibs~onchT
~ ~ permitted acres
-~tf~ - acres
~3 acres

$2.344.00 application fee
$2.906.00 quarry application
$1.938,00 amendment fee
$2.344.00 conversion fee
2. / 1bs/Tons/vr
3. / lbs/TonsFrr 4. i lbs/Tons/vr 5. / Ibs/TovshT
5.2 Anticipated end use of primary commoditie(s) to be mined: ~ro~~_°~ ~ivt~ A rxvrt?~,G
5.3 Anticipated end use of incidental commoditie(s) to be mined:
Oif¢e of Ofilce of Colorado
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