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APPLICATION FOR AtR ~LLUTION EMISSION.PERM~T OR PER! MODIFICATION <br />This application. must be i led out completely except for 1 b 15: otherwise, app i'cation <br />sill be .considered incomplete - SEE INSTRWCTIONS ON'gEYER.SE SIDE. Mail completed application,. <br />APENS, and filing fee. to: SCatFanary'Sources Progreia, A}r.Pollutlon Contral Division, <br />Colorado Department of Health 4210 East llth Avenue Dei! er .C Iorado 80220. <br />I. PERMIT 70 BE ISSUED T0: ~ • <br />Midxey Sard & caravel, L,a. <br />2. MAILING AD RESS: <br />P.O. Box 3H3, Fonmtain State: ~ 817 <br />ZiP CODE: <br />3. AG T FOR SERVICE See No. 9 on reversn , <br />Dcxiald S. 1{eLl~rm <br />a. GENERAL NATURE OF BUSI ESS: b. SIC Code: <br />end and gravel opetatirn • <br />5a. AIR OLLUTION $ UR E DESCRI TION: 5,4- Days per year <br /> source wiil'.operate <br />E.J. 45" cane crusher serial C-0679, Model 72-13 7b0 <br />a. SOURCE IOf.ATION ADDRESS: Check 1 map Inc uded: b. UTM Loor~~nates <br /> (ln,km): <br />COUNTY ' _ _ _ _ H _ _ _ •,y <br />). ESTIMATED COSTS: Air Po11ut1on Control Procedures or Equipment: <br />7a. Source, Process Equipment or Project: 7b: Capital Cast:b .~_`Annualized:5 <br />T <br />Lap. <br />Cos2:~- Annuallzed:$ 7c. Operetl~g Co6R' S-.~•~ ~ /Yr <br />a: TATUS <br />® New Air Pollution Source . <br />^ Existing Source Change (Control equipment added, process change, etc.): <br />[~ Other: rr. <br />Pro ected.Dates for Construction to: Protected Source tart p Data: <br />8b. Bealn: 8e. End: <br />--~- 8d, June 15, 1948 <br />Enc oge check to cover ADEN FfLING FEES. One should ;lie' ".bd; P~ eacp em,•ss on'poiitt:. <br />3 APEHs @ $40.00 per APEN ~ S ~'~ <br />10. SIGNATUR OF LEGALLY AUTHORIZED PERSON NOT ven or 1 a. D TE 'O E = 1 b. .EL PHONE MO:: <br />~ r equipment man facturer): ~;~ ~9) ~~~0 <br />ryfrS~ <br />~ o f <br />12. Type or pr nt name and o icial tit n o persons going tem 10. ancY Use On '. <br />ED <br />E <br />E <br /> IV <br />REC <br />14. DAT <br />Ikxiald S. }IeLlnenn, President <br />I Check appropriate box 1 you want: <br />a. ^ 'Copy of preliminary analysts conducted by Division <br />^ To review a draft of the permit prior to issuance? <br />b <br />. <br />NOTE: Checking either item could result in.lncreased fees 1 .. RHIT NUMBER <br />or processing time. See Reverse. ~~ <br />APCD:SSP:2000 (Rev. 1/84) <br />