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AISPLICATION FOR AIR POLLVITON EMISSION PERMIT OR PERMYf MODIFICATION <br />s application must be filled out completely except for /U and /IS: otherwise, applir~tion will be ooasidered incomplete -SEE <br />~STRUCTIONS ON REVERSE SIDE. Mail completed applin(ioo APENa and filioy fee to: <br />Colorado Drparrment of Acalth <br />APCD-SS-BI <br />' <br />1300 Cherry Crre4 Drive South <br />Denver, Colorado 80222-1530 Tckphone: (303)692-3150 <br />Ptrmil to be issued to: <br />Connell Resources <br />Mailing Address: State: CO <br />4305 East Harmony Road, Fort Collins <br />80525 <br />Tip Code.• <br />'. Agent jar Servire (See No. 3 on re>,crse): <br />36. Federal Taz ldenr~cafion Number: 84-0588541 <br />C.enernl Nature of Business: 4b. S/C Code: <br />A e ate extraction and rod <br />,. Air Pollution Sourre Description: Sb. Days per year tourre will <br />Aggregate Extraction, Haul Roads oPermr: 300 <br />Sourre Location Address (include Lorotion Map): 6b. UI]N Coordinatts (rn km) <br />Township 6 North, Range 68 West, S.W. '., of Section 3 --- • - H _ _ _ _ . _ V <br />N.W. Corner of Intersection of I-25 and CotmtY Road X36 <br />N rv~ T>sAip .d a.op, ri... Cim:m d J:~c bm ~~ w r Ywafa~ County: <br />ESTIMATED COSTS: Air Pollution Control ProoPdures or Equipment <br />7a. Source, Proress Equipment or Project 7b. Capita! Cott: j <br />Cap. Cost S 7c. Optrating Cost: S <br />STATUS <br />m New Air Pollution Sourer <br />Mod~carion ro Permitted Sourer (Control EquiprtN added, proaerr ehartge, etc.J: <br />Transfer ojOwnership - Transjmrd from: <br />^ Erisring Sourre- nor permitted (Ineludr Darr ojSourre Start-up): <br />Other: <br />rojectrd Dates for Construehon to: Projrded Soura Smrfup Date: <br />b. Begin: October, 1995 &. Eod: 2005 8d• October 1995 <br />Enclose check to rom APEN FBJNG FEES. One APEN should br filed for tack onission point <br />NOTE: Additional processing jets must also br paid prior to pmnit issuanre. <br />1 APENS ®5100.00 per APEN = S 100.00 <br />.SIGNATURE OF LEGALLY AUTHO PERSON (JOT Vendor or l la. Date Sigrttdr ] lb. Telephone No.: <br />Equipment ManufacurrrJ / <br />1970 223-3151 <br />~_ <br />. Type or Print none and official title ojperson signi 't 10. <br />A¢encv Use Only <br />David Simpson, Vice President 14. DATE RECEIVED: <br />13. Check appropriate box if you want: <br />^ Copy ojpreliminary analyse ronduced by Division <br />^ To rrvitw a draft of the permit prior to l:rtusnreT 15. PERMff NUMBER <br />~: o~.:a.~~~:r.~rrrrvr.~aa~t... <br />V.ssrlu; R.. W:~.L ~L~iml~Wi. <br />