REV17355

• Permit No: M1978172
• IBM Index Class Name: Revision
• Doc Name: EXHIBIT M OTHER PERMITS & LICENSES ANTELOPE HILL GRAVEL PIT
• Type & Sequence: AM1
• Media Type: D
• Archive: No

This application must be tilled t completely except for pl 15; otherwise, application
.iill be considered incomplete -~E INSTRUCTI0115 OH REVERSE SI~ Hail completed application,
APEIIS, and flung fcc to: Stationary Sources Program, Air Pollution Control Division,
('n lnrado Dcoartmcnt of Flcalth, 4210 East Ilth Avcnuc. Dcnvcr, Colorado 80220. (303/ 331-8516)
I. PERMIT TO DE ISSUED T0:
Delta County
2. HAILING ADDRESS:
State: Colorado
• zIP coDE:81416
5(17 P~ In,PY CI'YPPf nPt Y~
3. AGENT FOR SERVICE (Sec No. 3 on reverse);
Delta County Commissioners
4a. GEItERAL IIATURE OF BUSINESS: +b. SIC Code:
County Government
5a. AIR POLLUTI011 SOURCE DESCRIPTION: CIIECK IF EQUIP. IS PORTABLE 56. Days per year
source will operate
Gravel Pit Operation - Crushing unit 168
a. SOURCE LOCATIOtI ADDRESS: Check if map included: b. UTH Coordina[e5
• (in km):
See a t taclled P1ap Locations COUt1TY Delta H V
7. ESTIMATED COSTS: Air Pollution Control Procedures or Equipment:
7a. Source, Process Equipment or Project: 76. Capital Cost:$ n~~_Annualized:$ n a
Lap' n/a n/a
Cost: $_ Annualizcd:$ 7c. Operating Cost $ 9.600.00 /Y r•
a. STATUS
® New R,ir Pollution Source
[] Existing Source Change (Control equipment added, process change, etc.):
^ Other':

Projectt.d.Dates for Construction to: Projected Source S[ar[up Date:
8b. Oeain: immediate8c. End: ongoine 8d• immediately

y. Enclose check [o cover APEN FILING FEES. One F.PEN should be filed for each emission point:
4 (cD~m
1 APEtIs @ ,590:00 per APEN = $ 60.00
10. SIZE OF LEGALLY AUT110RIZED PERSON NOT vendor Ila. DATE SIGNED: Ilb. TELEPHONE t10.:
or u+~: ent manuf~ cure ( 3(13) 874-7595
t 7 1989
12. Type r riot name and official title of person signing item 10. Agency Use Only
• DATE RECEIVED
J.V."Jim" Coan. Commissinn~r Chairman
13• Check appropriate box if you want:
a. ^ C~~py of preliminary analysis conducted by Division
b. ^ Ti review a draft of the permit prior to issuance?
NOTE: Checking either item could result in incrcaseJ fees 15. PERMIT IIUnBER
or processing time. Sec Reverse.
APCD:SSP: (Rev. 11/81 - 1214f)
Doc~4 2000