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~; .. III ~II~II~II~~II III sss S k P 141988 LIMITED IMPACT OPERATION (110(2)) PAINEDI-AND APPLICATION FORM (lECLNMgTIpN DIVI$IpN The Application fora Limited Impact Operation Reclamation Permit contains three major parts: (1) the Application Form, (2) the Application Exhibits A-F, and (3) the application fee. When you submit your Application, be sure to include two si ned copies of the Application Form, tvro copies of Exhibits A-F, and a check for the app rca ion fee described under (4) below. 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 described below. ----------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- 1. Applicant/Operator Name: Deer Trail Sand & Gravel 2. Operation Name (Pit, mine or site name): Deer Trail Sand & Gravel 3. Application type: Limited Impact Operation (110). 4. Application Fee for Permitted Acreage* 9.946 permitted acres. (;10 x (affected acres) + ;25.00).* Note permitted acreage and application fee and attach a check for this amount when you file. $125.00 application fee. 5. Substance(s) to be mined (e.g., gold/silver/gravel): sand & G ravel 6. Owners (s) of Substance to be Mined (check applicable box(s)): X Private State Federal Indian 7. Owner(s) of Record of Affected Land (check applicable box (s )): X Private State Federal Indian 8. Type of Mining Operation (check applicable box (s )): X Surface _ Underground _ In-situ 9. Location Information. The center of the area where the majority of mining will occur lies in: COUNTY: Arapahoe PRINCIPLE FiERTD A c ec one 6th (Colorado) 10th (New Mexico) Ute TOWNSHIP (write number and check direction): T 5 _ North X South RANGE (write number and check direction): R 60 _ East ~ West SECTION (write number): S 24 QUARTER SECTION (check one): ~)~ NW SE g SW QUARTER/QUARTER SECTION (check one): = NE ~ NW _ SE _ SW GENERAL DESCRIPTION: (miles and direction Approximately one mile southwest of Deer Trail, from nearest town and approximate elevation) Colorado. Elevation = 5300 feet. 1 * If the operator is a unit of State or county government, an application fee is not- required. A fraction of an acre must be counted as one acre for fee calculation.