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OMB No. 2040-0042 Approval Expires 1/J1/OS <br />Uni[¢d Stat¢s Environm¢nlal Prot¢ction Ag¢ncy <br />~ Underground Injection Control na c <br />\"/EF'A Permit Application <br />^ <br />(Col/ected under the authority o/ the Safe Drinking U <br />Water ACt. Sections 1411, 1411, 40 CFR 144) <br />Read Attached Instructions Before Starting <br />For Official Use Only <br />Application approv¢d Dat¢ reeeiv¢d <br />P¢rmit Number Well ID FINDS Number <br />mo day year mo tlay year <br />((~~''~~ <br />l~~ <br />O me _ Owner Name <br />~- <br />SWTKO Ioint Venture, LLC _ SWTKO <br />~ <br />Str¢¢t Atltlr¢ss Phone Number Street Address Phone Number <br />333 W. Hampden, Suite 810 ~ (303 534-1040 333 W. Ham den, Suite 810 (303) 514-104 <br />C ___ Stat¢ ZIP CODE Cit Stat¢ ZIP CODE <br />Englewood _~ CO 80110 Englewood l CO 80110 <br />Ves ~ Private ~. Owner 2l2-Aggregate Extraction <br />e <br />® <br />No ~ Federal <br />Operator <br />Oth¢r <br />A Date Started ~ B. Modl(icatlon/COnv¢rsion Qx C. Proposed <br />mo day year <br />Operating ~---~-1 <br />-1 <br /> <br />Number of Ezisting Wells Number oT Proposed W¢Ils Name(s) of field(s) or projectts) <br />r^~ <br />®A. Individual LI B. Area <br />-- <br />~~oo <br />i~~ ~_____~ RS-A <br />A. Class(es) 6. Typ¢(s) C. If class is "other" or type Is cod¢'x; ¢xplain D. Number of wells per type (if area permit) <br />(enter code(s)) (enter cotle(sp 2 <br />~~ <br />Latitud¢ Langitud¢ Township and Range ~ Yes <br />Deg M~ ~ Deg M~ ~ ~ _7~'ip__. R~ 1/~ Fee L~ Fee LO ~ No <br />40 03 6 104 49 0 IN 66W 18 NE <br />(Complete the following questions on a separate sheet(s) and number accordingly; see instructions) <br />For Classes I, II, III, (and other classes) complete and submit on a separate sheet(s) Attachments A••U (pp 2-b) as appropriate. Attach maps where <br />required. List attachments by lett¢r which are applicable and are includ¢d with your application. <br />I certify under the penalty of law that I have personally azamined antl am familiar with the information submitted In this tlocument and all attachments <br />and that, based on my Inquiry of those individuals Immediately r¢sponsible for obtaining the information, I b¢Ileve that the Information is true, <br />accurate, and complete. I am aware that there are significant p¢naltles for submitting false information, Inclutling the possibliity of fine and <br />imprisonment. (Ref. 40 CFR 144.72) <br />A. Nam¢ antl Title (Type or Print) <br />__ ____. _-. B. Phone No. (Area Code and No.J <br />- <br />-- <br />-- <br />~ <br />~ r <br />- <br />_ <br />~ <br />C. Signature (D. Date~Signed ---t <br />L J <br />EPA Form 7520-6 (R¢v. 8-01) <br />