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Permit Number: <br />AIRS ID Number: <br />[Leave blank unless APCD has already assigned a permit 9 and AIRS ID] <br />Section 3 - General Information <br />Project Name: Williams Fork Property - Land Reclamation <br />General description of land development project: Demolition and removal of existing facilities, <br />land regrading, soil material replacement, and reseeding of reclaimed areas <br />Street Address (if applicable): Approximately 7 miles south of Craig, on State Highway 13 <br />County: Moffat Section: 31 Township: 6N Range: 91W <br />Project Timeline <br />Date earthmoving will commence: 03/01/18 <br />Date earthmoving will stop: 07/01/20 <br />Estimated time to complete entire project (includes buildings): 28 months <br />Proiect Area <br />Total area of project subject to earthmoving: 100 acres <br />Maximum disturbed area at any one time: 60 acres <br />Paving_ <br />❑✓ Check box if no paving will be completed at this location. <br />Area to be paved: acres Date paving to be completed: <br />List any known or suspected contaminates in the soil: <br />None <br />NOTE: Contaminated soil may prevent your project from being covered by the General Permit GP03. <br />Brief description of how project development will occur: <br />(May consist of timeline, project phases, etc. Attach additional pages if necessary.) <br />Facility demolition and removal will occur first, followed by regrading to final configuration (2 phases) <br />soil materials will be replaced on regraded areas, and reseeding will follow during spring/fall <br />IF YOU HAVE REQUESTED COVERAGE UNDER A GENERAL PERMIT, AN AUTHORIZED <br />SIGNATURE IS REQUIRED HERE. IF YOU HAVE REQUESTED COVERAGE UNDER A <br />CONSTRUCTION PERMIT, AN AUTHORIZED SIGNATURE IS REQUIRED ON PAGE 4. <br />I hereby certify that all information contained herein and information submitted with this application is <br />complete, true and correct. I further certify that this source is and will be operated in full compliance <br />with each condition of�q ral permit GP03. <br />Sign <br />Jerry Nettl <br />Name (please print) <br />Person (not a vendor or consultant) <br />/ pate <br />Mgr. Environmental Affairs <br />Title <br />COLORADO <br />Form APCD-223 - Land Development APEN 2 1 Adikv <br />