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APPLICATION FOR A.IR POL&ON CONSTRUCTION PERMIT 040U41T MODIFICATION <br /> application must be filled out completely except for#14 and #15: otherwise, application will be considered incomplete- SEE <br /> UCTIONS ON REVERSE SIDE. Mail completed application APENs and filing fee to: <br /> Colorado Depaniment of Public Health and Environment <br /> APCD-SS-Bl <br /> 4300 Cherry Creek Drive South <br /> Denver, Colorado 80222-1530 Telephone: (303)692-31S0 <br /> 1. Permit to be issued to: <br /> 7 WESTERN SLOPE FLAGSTONE -- QUARRY NO.2 <br /> 2. Mailing Address. 3316 E 3/4 Road, Clifton SQ!° CO <br /> uP Code-- 81520 <br /> 3a. Agenr for Senior (See No. 3 on reverse): NONE <br />'I 3b. Federal Tax Identification Number: 84-0980471 <br /> 4a. General Nature of Business. RIP/RAP MINING 4b. SIC Code: 1420 <br /> Sa. Air Pollution Source Description: MINE / HAUL ROAD 5b. Days per),ear source will <br /> operate. 90 <br /> 6a. Source location Address (Include Location Map): 6b. UTM Coordinates rin Ann) <br /> 1 t Mile SE Cameo, CD J33. • .Q H 4335 . 2V <br /> 1�9 SW1/4 Section 35, T10S, R98W, 6th P.M. <br /> . sty W ate.0.Mk=-h bra 6M........Yoahah County: MESA <br /> 7. ESTIMATED COSTS: Air Pollution Control Procedures or Equipment <br /> 7a. Source, Process Equipment or Project. 7b. Capital Cast: S 7,500.00 <br /> Cap. Cost S 55,000 7e. Operating Can: S 1 ,500.00 <br /> 8a. STATUS <br /> 13 New Air Pollution Source <br /> ❑ Modification to Permitted Source (Control Equipment added,process change, etc): <br /> ❑ Transfer of Ownership — Transferred from: <br /> ❑ Existing Source- nor permitted (Include Date of Source Stars-up): <br /> ❑ Other: <br /> Projected Dotes for Construction to: Projected Source Stamp Date: <br /> 8b. Begin: 10/1996 8c• End: 2017 8d• 10/1996 <br /> 9. Enclose cheek to cower APEN FLUNG FEES. One APEN should be filed for each emission point <br /> NOTE: Additional processing fees must alto be paid prior to prams Issuance. <br /> 1 APENS C $100.00 per APEN - S 100.00 <br /> 10. SIGNATvRE OF L EGAILY AU7HORMW PERSON(LO2 Vandor or l la. Date Signed: I lb. Telephone No.: <br /> Ill Equipment Manufacturer) <br /> 970 934-7948 <br /> 12. 7)pe or Print narne and official title of person signing item 10. <br /> WESTERN SLOPE FLAGSTONE Aeoncy Use Only <br /> Rudolph Fontanari owner 14. DATE RECEIVED: <br /> Check appropriate box if you want: <br /> ■. 0 Copy of preliminary analysis conducted by Division <br /> b. 0 To review a draft of the permit prior to issuance? 15. PERMfr NUMBER <br />