PERMFILE111685

• Permit No: M1987116
• IBM Index Class Name: Permit File
• Doc Date: 7/6/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

a ~
.;
-z-
10. Correspondence Information
APPLICANT/OPERATOR (name, address. and phone of name to be used on permit.)
Individual's Name: Bill Tezak
Company Neme:
Street:
City:
State:
Area Code:
PERMITTING CONTACT
Colorado Quarries
15th 8 Waters
[`a nnn city
co Zip Code: aiziz
303 Telephone: [phone]
(if different from applicant/operator above)
Individual's Name:
Company Name:
Street:
City:
State:
Area Code:
Zip Cade:
Telephone:
INSPECTION CONTACT (if different from applicantloperator above}
Individual's Name:
Company Neme:
Street:
Ctty:
State:
Zip Code:
Area Code: Telephone:
11. Primary future ^ Cropland(CR) ' ^ Pastureland(PL) ^ General Agriculture(GA)
land use ® Rangeland(RL) ^ Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreatlon(RC) ^ Industrial/Commercial(IC)
^ Developed Water Re sources(WR) ^ Solid Waste Dlsposal(MD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL). ^ General Agriculture(GA)
land use ® Rangeland(RL) ^ ForestryiFR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Re sources(WR)
To the best of my knowledge. all the information presented on this application form and
the attac/hed Exhibits ~Aj-G are true and correct (must be si ned by applicant/operator).
Date• (~ ~ ~lt - O ~ By: