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TATE OF <br />DIVISION OF MINERALS AND GEOLOGY <br />r~~ o33a <br />GIE# l 032 <br />COLORADO <br />Department of NaNraF Resources <br />1 31 3 Sherman 8t., Room 215 (z [+ r''J <br />Denver, Colorado 80?03 R~'~`-`,~ <br />Phone. (303) 866-3567 <br />FAi: (303) 833-8106 SEP '1 ~ 7997 <br />CONSTRIICTION MATERIALS pIVISICfI 0` ~~+~'"~'EfUIS `^ v°O~u'_~. <br />LIMITED IMPACT (110) OPERATION <br />~~~~ N <br />F <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />Rov Romer <br />Governor <br />RECLAMATION PERMIT APPLICATION FORM lames S. LOChhead <br />Eze<un ve Dvenor <br />Michael B. Long <br />Division Director <br />CHECK ONE: X New Application (Rule 1.4) Ameadment Application (C.R.S. 34-32.5-110) <br />Conversioa Application (Rule 1.11) <br />Permit # - -_ (provide for Amendmeata and Coaveraioas of <br />existing permits) <br />The application for a Construction Materials Limited Impact (110) Operation Reclamation Permit <br />contains three major parts: (1) the application form; (2) Exhibits A-J, Exhibit L, Addendum 1, <br />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)(b); and (3) the application fee. When you <br />submit your application, be sure to include one (1) complete"sicned and notarized IVORY ORIGINAL <br />and one (1) copy of the completed Ivory application form, two (2) copies of Exhibits A-J, <br />Exhibit L, Addendum 1, and appropriate sections of 6.5 (Geotechnical Stability Exhibit), as <br />required, and a check for the application fee described under (4) below. Exhibits should NOT be <br />bound or in a 3-ring binder; maps should be folded to 8 1/2" X 11" or 8 1/2" X 14" size. To <br />expedite processing, please provide the information in the format and order described in this <br />form. <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the syace provided, ALL informatioa described below. <br />---------------------------------------------------------------------------------------------- <br />---------------------------------------------- ------ ------------------ <br />1. Applicaat/operator or company acme (aame to ba used oa permit): <br />OuraV Associates LLC <br />1.1 Type of organization (corporation, partnership, etc.): Limited Liability Corporation <br />1.2 I.R.S. Tax ID No. or Social Security Number: <br />2. Operation name (pit, mine or site name): Memphis <br />3. Permitted acreage (aew or existing aite): 2.44 permitted acres <br /> 3.1 Change in acreage (+ or -) acres <br /> Total Acreage in Permit Area 7.44 acres <br />4. Fees: <br /> 4.1 New Application 5875.00 application fee <br /> Amendment Fee (C.R.S. 34-32.5-125(II)) 5575.00 application fee <br /> 4.2 Conversion Fee (from 110d to 110 875 5.00 conversion fee (Rule 1.11.2(2)) <br />5. Primary commoditie(s) to be miaefl: Wee#,~pack/A3~nwinm <br /> 5.1 Incidental commoditie(s) to be mined: 1. 15,000 lbs/Tons/yr <br /> 2. / 16s/Tons/vr 3. / lbs/Tons/yr <br /> 4. / lbs/Tons/vr 5. _ ~ lbs/Tons/vr <br /> 5.2 Anticipated end use of primary commoditie(s) to be mined: Road Base/Fill <br /> 5.3 Anticipated end use of incidental commoditie(s) to be mined: N/p <br />