Hah, oh man it took me so long to get this thing working properly. Here's what happened:
At first I put a decent amount of arctic silver 5 on the gpu and ceramique on the ram chips. I turn on my computer and feel the card where the gpu is. Immediately I think to myself, "Hm that feels really hot." Sure enough, I look at the temp reading right after booting to xp and it reads 120 C. So i quickly scream and kill the psu. I then replace the as 5 with ceramique and, after the as 5 incident, I decide to apply thin layers. My card maxes around 90 using rthdribl with the multisampling maxed out. That's way too high so I try different thicknesses of ceramique. Finally I realize what the problem is. Firstly, the heatsink surface is very rough so you need a relatively thick layer of thermal paste on the gpu as well as the ram chips. Secondly, you need to make sure the gpu is totally touching the heatsink, which is what others have already told you, and it most likely isn't due to the ram chips. So, you just need to make sure that the four metal screws are very tight. Just try not to crack the board by tightening them too much. Now my card is at 50 C idle which is good enough for me since it used to be at 60 idle. I forget where exactly it peaks, maybe in the low 70s.