PERMFILE50455

• Permit No: M1987116
• IBM Index Class Name: Permit File
• Doc Date: 7/6/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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10. Correspondence Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit.)
Individual's Name: sill Tezak
Company Name: Colorado Quarries
Street: 15th & waters
City: (`Annn (`1tY
State: co Zip Code: 91212
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (1f different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
11: Primary future ^ Cropland(CR) ' ^ Pastureland(PL) ^ General Agriculture(GA)
land use ® RangelandLRL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS)^ Recreation(RC) ^ Industrial/Commerclal(IC)
^ Developed Water Resources(WR) ^ Solid Waste Dlsposal(WD)
12; Primary present ^ Cropland(CR) ^ Pastureland(PL). ^ General Agriculture(GA)
land use ® Rangeland(RL) ^ Forestry(FR) ~ ^ Wildlife Habitat(WL)
(check one): ^ Residentiat(RS) ^ Recreatlon(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR)
To the best of mY knowledge, all the information presented on this appticatlon form and
the attac//hed Exhibits A-G are true and correct (must be si ned by applicant/operator).
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