2005-10-18_REVISION - M2004078

• Permit No: M2004078
• IBM Index Class Name: Revision
• Doc Date: 10/18/2005
• Doc Name: Water Quality Monitoring Plan and Ditch Stabilization and Erosion Control Plan
• From: SW TKO Joint Venture LLC
• To: DMG
• Type & Sequence: TR2
• Media Type: D
• Archive: No

OMB No. 2040-0042 Approval Expires 1131105
United Stales Environmental Protection Agency
\~i~~A Underground Injection Control T/A c
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Permit Application
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(Collected under the authority o/ she Sale Drinking U ( I
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Water Act. Sections 1411, id22, d0 CFR id1)
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Read Attached Instructions Betore Starting
For Official Use Only
Application approv¢d Date received
Permit Number Well ID FINDS Number
mo day year mo day year
O Owner Name
S WTKO Joint Venture, LLC S WTKO
Street Addross Phon¢ Number Street Address Phone Number
~ [phone] 333 W
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810---^~
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4
1
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amp
amp
en, Suite 810
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te
(3
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333
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3) 53
C Stale ZIP CODE Cit State ZIP CODE
Englewood ~ CO SO(l0 Englewood ~ CO 80110
yes Private ~. Owner 212-Aggregate Extraction
®
B
No ~ Federal
Operator
Other
A Date Started ~ B. MotlificationlConvarsion Q C. Proposed
mo day year
Operating I--'-~--1
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Number of Ezisting Wells Number of Proposed Welts Name(s) of geld(s) or project(s)
i.! A
Individual ~ B
Area
.
.
~~ RS D.----- -_ 1
A. Class(es) B. Type(s) C. If class is "other" or type Is codex; explain D. Number of wells per type (if area permit)
(solar code(s)) (enter code(s))

Latitude Longitude Township and Range
yes
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Oe Min Sec Da Min Sec Sec Tw Range 114 Sec Feat From Line Feet From Llne No
OI 44
4
IN 66
NW ~ 0 ~ 0
W 30
40
l04 48
7
(Complete the following questions on a separate sheet(s) and number accordingly; see Instructions)
For Classes 1, II, III, (and other classes) complete and submit on a separate sheet(s) Attachments A-U (pp Z-6) as appropriate. Attach maps where
required. List attachments by letter which are applleable antl are included with your application.
I eertiry under the penalty of law that I have personally examined and am familiar with the information submitted in this document and all attachments
antl that, based on my Inquiry of those individuals immetlialely responsibl¢ (or obtaining the information, I believe that the information is true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, Including the possibility of fine and
Imprisonment (Ret. 40 CFR 144.32)
A. Name and Title (Type or PrInQ
` B. Phone No. (Area Cotle antl No.)
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C. Signature D. Date-S~i g-n~ed-'•°--~
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EPA Fonn 7510-6 (Rev. 6-0i)