Laserfiche WebLink
GEIN'ERAL PERMIT APPLICATION For Attency Use Only <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH COR -50 <br />SAND AND GRAVEL PRODUCTION <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 />t o r Yes Maintenance/equipment wash waters <br />a <br />F <br />Yes Transport waters (e.g., slurries) <br />0 Yes Scrubber waters (cnishers or classifiers) <br />No * Yes Mine dewatering (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 permk auplicant: <br />Company Name: <br />Federal Taxpayer <br />Mailing Addrrss: <br />City, State and Zi <br />Phone Number. (221> A6:7 - 2 44 1 Who is applying for the permit? jLwn Operator <br />Local Contact (familiar with facility): G • 5 T ra C1lNe <br />Title: R- <s u ey't Phone Number j 7 D) 6 7— 2 9 9 <br />3. Location of the facility_ <br />Street Address: '7)R ! <br />City, State and Zip Code: <br />County: L'A 1ra M At— Narne of facaity: -InI,aSrw� <br />Legal Location (Township, Range, section, 1/4 section): AICE� <br />Latitude and Longitude: I/D. ( a /U I a! -r 4 a <br />Type of Facility: 0 New (beginning operations after 1011/92) <br />7/93isg - I - <br />0 sttrig (as of 10/ <br />4�hk?/? <br />