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Application For Discharges Associated With Sand & Gravel Mining And Processing www.coloradowaterpermits.com <br />H. SITE - SPECIFIC CONDITIONS: <br />a. Does this facility have bulk storage of diesel fuel, gasoline, solvents, fertilizer, or other hazardous ❑ NO a YES <br />materials on site? <br />b. Is this operation located within one mile of a landfill, or any mine or mill tailings? ❑ NO ❑ YES <br />C. Does the dewatering area have or possibly have groundwater contamination, such as plumes from a NO ❑ YES <br />leaking underground storage tanks, etc.? <br />If YES for any of the above questions, show location of the landfill, tailings or possible groundwater contamination on the location map <br />in item 7 or in the general sketch in item 8. Please explain the location, extent of contamination, and possible effect on the discharges <br />trom this tacility. <br />FSecondary containment of fuel storage tanks Will be 150% of capacity as required. <br />d. Is all stormwater runoff from the facility discharged with the facility's process water discharge(s)? ❑ NO a YES <br />I. CHEMICAL TREATMENT <br />Will any flocculants (settling agents or chemical additives) be used to treat water prior to discharge? a NO ❑ YES <br />If YES, list here, and include the Material Safety Data Sheet (MSDS): <br />Chemical Name * Manufacturer Purpose In Which Waste Stream? <br />NONE <br />* If the chemical formula is unknown or confidential, provide the manufacturer's name, contact person, address and phone number <br />or a copy of the manufacturer's brochure, product label information or materials handling data sheet for each product used. Please <br />list the major constituents or active ingredient(s), if known. <br />J. FLOW MEASUREMENT <br />What method of flow measurement will be used for each discharge point (e.g., v -notch weir, pump capacity, parshall flume, etc.)? <br />NONE <br />page 5 of 7 revised Jan 2014 <br />