PERMFILE66283

• Permit No: M1987028
• IBM Index Class Name: Permit File
• Doc Date: 2/23/1987
• 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: Bill Tezak
Company Name: Colorado Quarries, Inc.
Street: 15th & Water Sts. P.O. Box 1389
• City: Canon C1tY, ~I
State: coloraao Zip Code: 81z1z
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if different from app1lSant/operator above)
Individual's Name:
Company Name: ^
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if 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): ^ Residentiat(RS)^ Recreation(RC) ^ Industrial/Conrnercial(IC)
^ Developed Water Resources(WR) ^ Solid Waste Disposal(WD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL). ^ General Agriculture(GA)
~~ land use O Rangeland(RL) ® Forestry(FR) ~ ^ Nildlife Habitat(WL)
(Check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Comrnercial(IC)
^ Developed Water Resources(WR)
To the best of nay knowledge, all the information presented on this application form and
the atta hed Exhibits A-G are true and correct ( be sig~ne/d~by applicant/operator).
Date: ~~ ~ By ~e.[O~ /
President
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