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GENERAL PERMIT APPLICATION <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />For Arency Use Only <br />COR -50 <br />OPERATIONS (AND OTHER Date Received <br />NONMETALLIC MINERALS Year Month Day <br />EXCEPT FUEL) <br />(Permit No. COG - 500000) <br />Please print or type, Do not attempt to complete this form before reading the instructions. <br />1. Is this the correct application for your facility?? This application is only for the discharge of stormwater. <br />Do you discharge any of the following process generated wastewaters from your facility? <br />No Yes Product wash waters <br />X1/0., Yes Maintenancefequipment wash waters <br />0 �No ; 0 Yes Transport waters (e.g., slurries) <br />Yes Scrubber waters (crushers or classifiers) <br />No * Yes Mine dewatermg (groundwater and/or runoff from the mine) <br />If you answered Yes to any of these questions, do not complete this application. You must instead complete the Process <br />Water and Stormwater Discharges Associated with Sand and Gravel application for this facility, which is available from <br />the Division. <br />2_ Name and address of permit aoolicant: <br />Company Name: <br />Federal Taxpayei <br />Mailing Address: <br />City, State and Zi <br />Phone Number. (Q 2D 667 - 2�1- W.ho is applying for the permit? 'w jamn-0 w Operator <br />Local Contact (familiar with facility): p k► t C. S -F ra LAe- <br />Title: -R- C u d ep± Phone Number: (V47 D) el el-7-2-9-91 <br />3. Location of the facility: <br />Street Address: l 4. <br />City, State and Zip Code: L o,eQ In A a fn a o 5 -:s6$ Ili <br />County: LArI _{'— Name of facility: MAC- Co411. i lo- -i V1 S 1 D A <br />Legal Location (Township, Range, section, 1/4 section):.i� -,�J et '�-�i l -�A <br />Latitude and Longitude: '71i 6 u / ri3 � o i+r <br />Type of Facility: * New (beginning operations after 10(1192} sting (as of 10/ <br />7/93/sg <br />a <br />-1- <br />