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AIR POLLUTION C011TROL DIVISION - COLORADO DEPARTMENT OF IiEALTH <br />4210 E. 11th Avenue, Denver, Colorado (30220 - Phone: 320-41F30 <br />APPLICATION FOR EMISSION PERMIT z <br />s application shall be filled out completely - see instructions on reverse side. <br />1. PER141T TO BE ISSUED T0: Telephone Nu. L o3i 751-UOy3 <br /> Sl~erdian Ente•rDris:_s <br />2. MAIL1i~G ADDRESS (include zip code): 9745 East 11~ml~cic•n ,avenue <br /> No. 350 <br /> Denver, Colorado 80231 <br />3. TYPE OF ORGANIZATION: <br /> Dx Corporation ~ Partnership ~ Individual Owner ~ Governmental Agency <br />4. GENERAL NATURE OF BUSINESS: <br /> Coal Mining <br />5. EQUIPMENT - Pursuant to Regulation No. 3 of the Colorado Air Quality Control <br /> Commission, application is hereby made for an Emission Permit for <br /> the following equipment (attach separate sheet where necessary): <br /> See attached sheets <br />6. EQUIPMENT LOCATION ADDRESS: <br /> Munger Canyon <br /> Douglas Pass Road COUNTY: GARFIELD <br /> Garfield County, Colorado <br />7. ESTIMATED COST OF EQUIPMENT OR ALTERATIONS: <br /> Air Pollution Control Equipinent Basic Equipment _ <br /> Days Per Year Equipment Will Be Operated <br />8. STATUS (check and complete applicable items): <br /> New Air Pollutant Source Estimated Date Estimated Date <br /> Construction Construction <br /> Control Equipment Being Will Begin Will Be Completed <br /> Added to Existing Source <br />9. Check is enclosed to cover APPLICATION FILING FEE 540.00 <br /> (see No. 9 on reverse side of this form) <br />10. SIGNATURE OF LEGALLY AUTHORIZED PERSON ` <br />I 11. DATE OF APPLICATION <br />12. Type or print name and official title of person siyniny this application. <br /> Date Received <br />. ni-ri - ---r.--•Tr~--- <br /> <br /> <br />