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1 . <br />I <br />i <br />~~ <br />• <br />• <br />• <br />~~ <br />will'be .considered incomplete - SEE 1NSTRUCTlONS ON REVERSE SIDE. Mail completed appi~cacion <br />APENs, and filing fee to: Stationary Sources Program, Air Pollution Control Division, <br />Colorado Oeaartment of Health, 4210 East 11th Avenue, Denver, Colorado 80220. <br />i 1. PERH2T TO BE 15SUED T0: <br />Sand Creek Farms, Inc. <br />MAILING AUUKG~S: <br />6312 S. Fiddler's Green Circle Suite <br />AGENT FOR SERVICE See No. 3 on reverse ; <br />Allen J. Kincaid <br />State: Colorado <br />21P CODE: <br />an~ii <br />4a. GENERAL NATURE OF BUSINESS: b. SIC Code: <br /> Sand Excavation and Transport 312 <br />5a. AIR POLLUTION SOURCE DESCRIPTION: Sb. Days per year <br /> Extraction of Sand Material.and access road <br />source will operat <br /> Este attached m'n' '~ 30-120 <br />a. SOURCE LOCATION ADD ESS: Check if map included: b. UTM Coordinates <br /> (in km): <br /> West Bijou :Creek ~ 1/2 miles COUNTY Adams H <br /> _ _ _ _ <br />7. ESTIMATED COSTS: Air Pollution Control Procedures or Equipment <br /> Unk. <br />7a. Source, Process Equipment or Project: 7b. Capital Cost;$ Annualized:$ <br /> <br />Cap' Uiik'~`-. 7c. Operating Cost $ <br />Cost:$ Annuaiized:$ _ <br />/Yr• <br />a. STATUS <br /> © Mew Air Pollution Source <br /> ^ Existing Source Change (Control equipment added, process change , etc.): <br /> ^ Other; <br /> Projected.Dates for Construction Lo: Projected Source Startup Date: <br /> 8b. Beain: 6/92 8c. End: 6/Z002 8d. 6/92 <br /> <br />9. Enclose check to cover APEN FILING FEES. One APEN should be filed for each emission point <br /> 1 APENs @ $60.00 per APEN $ 60.00 <br />I0. SIGNATURE OF LEGALLY AUTHORIZED PERSON NO a or Ila. DATE SIGNED: Ilb. TELEPHONE NO.: <br /> or ui me [ m nufactur <br />(3031 220-8618 <br />X 5/08/92 <br />12. Type or print nom and official tit of person signing item 10. Agency Use Only <br /> i ~ATE RECEIVED <br />Allen J. Kinc id, Part-Owner <br />13• Check appropriate box if you want: <br /> a. ^ Copy of preliminary analysis conducted by Division <br /> 6. ^ To review a draft of Che permit prior Lo issuance2 <br /> NOTE: Checking either item could result in.increased fees 15, PERMIT NUMBER <br /> or processing time. See Reverse. f <br />~ <br />APCD:SSP:2000 (Rev. 1/84) <br /> <br />