2015-03-23_PERMIT FILE - M2015008 (2)

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STATE OF COLORADO For Agency Use Only COG50- Date Received Month Day Year REGULATION WATER BODY ID APPLICATION for DISCHARGES ASSOCIATED WITH SAND & GRAVEL MINING AND PROCESSING PHOTO COPIES, FAXED COPIES, PDF COPIES OR EMAILS WILL NOT BE ACCEPTED. Please print or type. Original signatures are required. All items must be completed accurately and in their entirety for the application to be deemed complete. Incomplete applications will not be processed until all information is received which will ultimately delay the issuance of a permit. If more space is required to answer any question, please attach additional sheets to the application form. Applications must be submitted by mail or hand delivered to: Colorado Department of Public Health and Environment Water Quality Control Division 4300 Cherry Creek Drive South WQCD -P -B2 Denver, Colorado 80246 -1530 Any additional information that you would like the Division to consider in developing the permit should be provided with the application. Examples include effluent data and /or modeling and planned pollutant removal strategies. PERMIT INFORMATION Reason for Application: ❑E NEWCERT ❑ RENEW CERT EXISTING CERT# Applicant is: ❑ Property Owner Fol Contractor /Operator IS THIS THE CORRECT APPLICATION FOR YOUR FACILITY? This application is for use by all industrial process water dischargers, or process water plus stormwater dischargers, engaged in sand and gravel production operations (and other nonmetallic minerals, except fuels). This application is for both active and inactive mining operations and concrete and asphalt batch plants at the facility. It is suggested that all applicants contact the Division of Reclamation, Mining and Safety at the Colorado Department of Natural Resources, for information on their rules and regulations for Sand and Gravel mining and processing. Are any of the following discharged from the sand and gravel production operation subject to this application? YES ® NO ❑ Product wash waters? YES ❑ NO ❑ Maintenance /Equipment wash waters? YES ❑ NO ❑ Transport waters (e.g. slurries)? YES ❑ NO ❑ Scrubber waters (Crushers or classifiers)? YES ❑ NO ® Mine dewatering (groundwater and /or runoff from the mine)? If the answer is YES to any of these questions, this is the correct application for the discharge. If the answer is NO to ALL of these questions, STOP NOW, and instead, complete the application for Stormwater Discharges Associated with Sand and Gravel Mining and Processing (COR340000). page 1 of 7 revised Jan 2014 Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr 5 Laboratory Services Division Denver CO 80246 8100 Lowry Blvd « w Phone (303)692 -2000 Denver CO 80230 Located in Glendale CO 303- 692 -3090 Colora&Deparmtat htto: / /www.cdphe.state.co.us of Public Health attd Environment For Agency Use Only COG50- Date Received Month Day Year REGULATION WATER BODY ID APPLICATION for DISCHARGES ASSOCIATED WITH SAND & GRAVEL MINING AND PROCESSING PHOTO COPIES, FAXED COPIES, PDF COPIES OR EMAILS WILL NOT BE ACCEPTED. Please print or type. Original signatures are required. All items must be completed accurately and in their entirety for the application to be deemed complete. Incomplete applications will not be processed until all information is received which will ultimately delay the issuance of a permit. If more space is required to answer any question, please attach additional sheets to the application form. Applications must be submitted by mail or hand delivered to: Colorado Department of Public Health and Environment Water Quality Control Division 4300 Cherry Creek Drive South WQCD -P -B2 Denver, Colorado 80246 -1530 Any additional information that you would like the Division to consider in developing the permit should be provided with the application. Examples include effluent data and /or modeling and planned pollutant removal strategies. PERMIT INFORMATION Reason for Application: ❑E NEWCERT ❑ RENEW CERT EXISTING CERT# Applicant is: ❑ Property Owner Fol Contractor /Operator IS THIS THE CORRECT APPLICATION FOR YOUR FACILITY? This application is for use by all industrial process water dischargers, or process water plus stormwater dischargers, engaged in sand and gravel production operations (and other nonmetallic minerals, except fuels). This application is for both active and inactive mining operations and concrete and asphalt batch plants at the facility. It is suggested that all applicants contact the Division of Reclamation, Mining and Safety at the Colorado Department of Natural Resources, for information on their rules and regulations for Sand and Gravel mining and processing. Are any of the following discharged from the sand and gravel production operation subject to this application? YES ® NO ❑ Product wash waters? YES ❑ NO ❑ Maintenance /Equipment wash waters? YES ❑ NO ❑ Transport waters (e.g. slurries)? YES ❑ NO ❑ Scrubber waters (Crushers or classifiers)? YES ❑ NO ® Mine dewatering (groundwater and /or runoff from the mine)? If the answer is YES to any of these questions, this is the correct application for the discharge. If the answer is NO to ALL of these questions, STOP NOW, and instead, complete the application for Stormwater Discharges Associated with Sand and Gravel Mining and Processing (COR340000). page 1 of 7 revised Jan 2014