PERMFILE65564

• Permit No: M1977136
• IBM Index Class Name: Permit File
• Doc Date: 7/5/1996
• Doc Name: REGULAR OPERATION 112 RECLAMATION PERMIT APPLICATION FOR PRATHER PIT FN 77-136
• Media Type: D
• Archive: No

APPLICATION FOR AIR POUC~ION CONSTRUCTION PERNIIT PERMIT MODIFICATION
T7eis application must be filled out completely exocpt for N14 and Ji15: otbenviae, applicuien will be coacideted incomplete -SEE
INSTRUCTIONS ON REVERSE SIDE. Mail completed applicuion APENe cad filing fee to:
t:ofando Drpartnreu ojPablic Atalth and Environment
APCD~SS-B!
Il?00 Clterq Creut Drive Soup
Drn-rr, Colorado 8 011 2-153 0 Tekphonr (303)6913150
1. Pmnir ro be issued to:
Rio Blanco County Road & Bridge Department
2. Mailing Addrers: Stmt: CO
P.O. Box KK
Meeker Zip Code: 81641
3a. Agem for Smicr (Sat No. 3 on mare):
3b. Federal Tar Identhaation Number: 84-6000798
4a, t;ertrsal Nmun of Business: 46. SIC Code:
County Government NA
Sa. Air Pollution Sours Daaiption: Sb. Days pa year room will
Operation of Gravel Pit operme: 30
6a. Soum I,octttron Addrrrs pncLtde Loraation Map): lib. U'lllf Cooniinattr (Fn bn)
_ H ____ V
Lat.
a.r.*a--r.ru~.o~~r~:.~a~~......~;a~ CounO'~ Lono.
7. ESTIMATED COSTS: Air Pollution Corttstul Procedures ar Equipment
7a. Soura, Proerss Equipmcnr or Projea: 7b. Capita! Cost: S NA
Cap. Cott S 7c. Operating Cart: S NA
ea. STATUS
8J( New Air PoUutlptt Soura '•
^ Modifroation to Permitted Source (Control Equipment added, proc>c+:s change, etc.):
O rrmasfer of Ownership - Traujemrd finvn.•
^ Existing Soura- not permitted (IneGde Dmt of Sours Srartwp).•
^ Other:
Projected Llrtes,ror Construction to: Projected Soura Startup Dhte:
8b. Begin: 8e. End: Sd.
9. Enclose check to rnsrr MEN FILING FEES. One MEN should lx frltd for each onission paint
NOTE: Additional prarssing fees mart afro be paid prior to pmnit isstrancr.
1 APENS ®5100.00 per ADEN ~ S t nn nn
10. SIGNATURE OF LEnttr AU3'fI0 PERSON (LVO,Z Vardar or 11a. Dme Signed: 116. Telephone No.:
Equipment Manufacturer) ~~ ; ~
'~ •.
~~~~c'-~'4 \970 878-5061
I2. 7ype or Prim name and affreial title of Anson signing Fran 10.
A¢eocv Use Onlv
Mr. Rick Ullom Supervisor 14. DATE RECEIVED:
13. Check appropriate box it you want:
Division
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opy of pre
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b. D To revit~v a draft of the permit prior to issuantt? 15. PERMIT NUMBER
Ma.: o.~ ..ew e. rare ~ :'sal r.. rig o~~ .i_. rr 4w.