PERMFILE136302

• Permit No: M1987028
• IBM Index Class Name: Permit File
• Doc Date: 2/23/1987
• Doc Name: LIMITED IMPACT OPERATION 110 APPLICATION FORM
• Media Type: D
• Archive: No

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10. Correspondance Information
APPLICANT/OPERATOR (name, address, and phone of name to be used on permit)

Individual's Name: Bill Tezak
Company Name: Colorado Quarries, Inc.
Street: 15th 8 Water Sts. P.O. Box 1389
City: canon City,
State: Colorado Zip Code: 81212
Area Code: 303 Telephone: 2~s-6894
PERMITTING CONTACT (if different from appllcant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code:
Area Code: Telephone:
INSPECTION CONTACT (if different from appllcant/operator above)
Individual's Name:
Company Name:
Street:
City:
State: Zip Code•
Area Code: Telephone:
11. Primary future ^ Cropland(CR) ^ Pastureland(PL) ^ General Agriculture(GA)
land use ^ RangelandCRL) ® Forestry(FR) ^ Wildlife Habitat(WL)
(check one): ^ Residential(RS)^ Recreation(RC) O Industrial/Commercial(IC)
^ Developed Water Re sources(WR) ^ Solid Waste Disposal(WD)
12. Primary present ^ Cropland(CR) ^ Pastureland(PL) . ^ General Agriculture(GA)
land use ^ Rangeland(RL) ® Forestry(FR) ~ ^ Wildlife Habitat(WL)
(Check one): ^ Residential(RS) ^ Recreation(RC) ^ Industrial/Commercial(IC)
^ Developed Water Re sources(WR)
To the best of rqy knowledge, all the Information presented on this application form and
the atta hed Exhibits A-G are true and correct ( be signed by applicant/operator).
Date: L~-~ By:P.CQ-¢~
President
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