Laserfiche WebLink
APPLICATION FOR A11~LLUTION CONSTRUCTION PEl~ OR PERMIT MC III IIIIIIIIIIIII III <br />This appliatiaa mint be filled out completely eiloept for I"14 and /15: otherwise, appGatiao will be considered incomplde -SEE <br />INSTRUCTIONS ON REVERSE SIDE. Mail completed applicatiaa APENa and filing foe to: <br />Calorodo Drparaaent ojPublic Aealllt oad Eavitoanuat <br />APCD,SS-Bl <br />~?00 Cherry Creek Drire South <br />DraPCr, ColalQdo 8 0213-1 53 0 Telephone: (303)691-3150 <br />1. Permit m be tuned to: <br />Rio Blanco County Road h Bridge Department <br />2 Mailing Address: ~~ CO <br />P.0. Box KK <br />Meeker Tip Cade• 81641 <br />3a Agent for Strviar (Ste No. 3 on muse): <br />36. Federal Tar ldcnt~oatlon Numlxr: 84-6000798 <br />4a. General Nature ojeusinus: 46. S1C Cade: <br />County Government NA <br />Sa Air Pollution Soura Description: Sb. Days per year sours wil! <br />Operation of Gravel Pit opcratr 30 <br />ba. Soum Location Address (Include lotwtion Nap): 1.75 miles Southwest of fib. UT1N Coordtnottr fur km) <br /> ---'-H ----'-V <br />Rangely, CO in the NW; of Section 10, T1N, R102W Lat. 40 04'27" <br />a.~..ra.=.y~~..o..a~~.+.:~e~~.+...~~o~ Cauuy: Rio Blanco Lon 108 50' 12" <br />7. ESTIMATID COSTS: Air PoBirtion Control Procedures or Equipment <br />7a. Soura, PtncYSS Equipment or Project: 7b. Capital Coot: S NA <br />Cap. Coat S 7c. Operating Ca~tt: S NA <br />8a STATUS <br />~( New Air Pallutitxi Sava <br />^ Madificntion to Permiaad Soura (Cantnol Equipment addtd, proarss diange, dC.): <br />^ Trarujer of Ownership - 7Fanrjemed fiwti: <br />^ Esirting soa,ar- not perniiaed preclude Date of Soutar Starr-tip): <br />^ ot-,er: <br /> <br />Projeued Dares jot Construuioq to: Projeued Sown Startup Dlote: <br />86. Begin 7_ 1 _q Be. End: Bd. <br />9. Enclose rhtat to mitt APEN FILING FEES One APEN should 6e Jied jot each emission point <br />NOTE: Additional procrssing jar must afro be paid prior to perniit isruanez. <br />1 APENS ®5100.00 per APEN = i Inn nn <br />10. SIGNATURE OF LEGALLY AUTHORQFD OT Ytrdor or l la Date Signed• 116. Telephone No.: <br />Equipment Mannfaaurrr) <br />- ~~ <br />4 <br />27 <br />95 <br />V7 <br />878 <br />1 <br /> - <br />- 0 <br />-506 <br />12. type or Print none and official title of person signing iron !0. <br />Ayencv Use Only <br />Mr. Rick Ullom Supervisor 14. DATE RECEIVED: <br />13. Check appropriate box if you want: <br />Divi <br />i <br />d <br />cr <br />d L <br />i <br />l <br />i <br />li <br />s aor <br />u <br />[ <br />ry <br />s <br />on <br />nary ana <br />ys <br />m <br />a. ^ Copy ojpre <br />b. ^ To review a drajl of the permit prior ro iuuanae7 15. PERMIT NUMBER <br />a~ v.~~r~r~re~r..u.~4~va..~ <br />