REV88042

• Permit No: M1981058
• IBM Index Class Name: Revision
• Doc Date: 10/3/1986
• Doc Name: UNITED SAND & GRAVEL CO DEBEQUE GRAVEL PIT COLO PN CO-0037940
• From: IVAN P KLADDER PC
• To: CDOH
• Type & Sequence: SO1
• Media Type: D
• Archive: No

-2-
1Q. Correspondance Information
APPLICANT/OPERATOR (name„ address, and phone of name to be used on permit)
Individual's Name: _ Thomas F. Latham ~ Gineer L. Latham
Company Name: _ NSA
Street:
City: _ neRe~ue
State: _ Colorado Zip Code: 81630
Area Code: 303 Telephone: [phone]
PERMITTING CONTACT (if diifferent from applicant/operator above)
Individual's Name: _ same as Abovr
Company Name: _
Street: _
City: _
State: _ Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from applicant/operator above)
Individual's Name: same as Above
Company Name: _
Street: _
c; ty : _
State: _ Zip Code:
Area Code: Telephone:
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) EIc General Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Nabitat(WL)
(check one): ^ Reside~ntial(RS)^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(WR) ^ Solid Waste Disposal(WD)
12. Primary present ^ Crople~nd(CR) ^ Pastureland(PL) ~ General Agriculture(GA)
land use ^ Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Reside~ntial(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Resources(iJR)
To the best of my knowledge, all the information presented on this application form and
the attached Exhibits A-P are true and correct (must be ned by app~ant/ope
Ddte: September 30, 1986 ~j': ~.~.ay
ThomasThomas Latha~~
~~ ,J
~~~
Gin r L. Latham