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Crusher/Screen APEN — Form APCD-221 <br /> Air Pollutant Emission Notice (APEN) and <br /> Application for Construction Permit <br /> All sections of this APEN and application must be completed for both new and existing facilities, including APEN <br /> updates. Incomplete APENs will be rejected and will require re-submittal. Your APEN will be rejected if it is <br /> filled out incorrectly, is missing information, or locks payment for the filing fee. The re-submittal will require <br /> payment for a new filing fee. <br /> This APEN is to be used for aggregate crushing and screening units only. If your emission unit does not fait into this <br /> category, there may be a more specific APEN for your source(e.g. mining operations, asphalt plant, engines, etc.). <br /> In addition, the General APEN(Form APCD-200)is available if the specialty APEN options will not satisfy your <br /> reporting needs. A list of all available APEN forms can be found on the Air Pollution Control Division (APCD)website <br /> at: www.colorado.gov/cdphe/apcd. <br /> This emission notice is valid for five(5)years. Submission of a revised APEN is required 30 days prior to expiration <br /> of the five-year term, or when a reportable change is made (significant emissions increase, increase production, <br /> new equipment, change in fuel type, etc.). See Regulation No. 3, Part A, II.C. for revised APEN requirements. <br /> Permit Number: AIRS ID Number: <br /> (Leave blank unless APCD has already assigned a permit«and AIRS ID] <br /> Section 1 - Administrative Information <br /> Company Name': Uinta Mining LLC <br /> Site Name: Skull Creek Sand Project <br /> Site Location: Site Location <br /> approx. 2.7 miles NW County: Moffat <br /> of Massadona, CO <br /> NAICS or SIC Code: 1499 <br /> Mailing Address: <br /> (include Zip Code) 6602 Ilex Circle <br /> Naples, Florida 34109 Contact Person: Robert Nead <br /> Phone Number: 239-825-2332 <br /> Portable Source <br /> Home Base: E Ma;t addressz: basic@altoncoal.com <br /> ' Use the full,legal company name registered with the Colorado Secretary of State.This is the company name that will appear <br /> on all documents issued by the APCD. Any changes will require additional paperwork. <br /> z Permits,exemption letters,and any processing invoices will be issued by the APCD via e-mail to the address provided. <br /> Form APCD-221 - Crusher/Screen APEN - Revision 3/2019 1 ® co�oa:I <br />