REV100619

• Permit No: M2003092
• IBM Index Class Name: Revision
• Doc Date: 10/12/2005
• Doc Name: Reclamation Permit Application Form
• From: Nick H. Gray
• To: DMG
• Media Type: D
• Archive: No

Colorado Department of Public Health and Environment
Air Pollution Control Division
N.
- MINING OPERATIONS -
Total Area of Site: / C' Acres
Total Disturbed Area of Site: g, S- Acres
Proposed Controls
~ Watering
^ Frequent (Watering Frequency of 2 or More Times Per Day)
~ As Needed
^ Chemical Stabilizer
Page 6 of 6
^ Revegaffition Revegeffition Must Occur Within One Year Of Site Disturbance
^ Seeding With Mulch
^ Seeding Without Mulch
® Other (specify) jlpyQyef,~ f/o.~ Wil/ ~cLUh f1.{fF1' A/l ~+~Y~ l Frtr.}cflOy/ it cc,.H~Iet
Additional Sources of Emissions
List any other sources of emissions and related controls (includes fugitive emissions)
r
of a
a vendor or consultant)
Date
-~
Nek N~ G~,~„ 4w,~~r
Name (please print) Title
Check the appropriate boz dyoo want:
^ Copy of Preliminary Analysis conducted by We Division
^ To review a draft of the permit prior to issuance
(Checking any of Utese boxes may result in an increased Fee and/or processing time)
This notice is valid for five (5) years unless a significant change is made, such as an increased production, new equipment, change
in fuel type, etc. A revised APEN shall be filed no less than 30 days prior to the expiration date of this APEN form.
Send this form along with $119.96 to: Colorado Department of Public Health and Envbonment
Telephone: [phone] Air Pollution Contrd Drtvion
APCD-SS-BI
4300 Cherry Creek Drive South
Denver, CO 8024Cr1530
Revised July 2001 h[tp://www. cdphe. state. co. us/ao/stationarv aso