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STORNIWATER ANNI IAL REPORT -SAND AND GRAM. <br />COLORADO DEP"r. OF PUBLIC 11EALT11 & ENVIRONMENT <br />Water Quality Control Division <br />WQCD-P-H2 <br />4100 Cherry Creek [hive South <br />f)cnvcr.Colorado 80246-1530 <br />4fake eaoaRh copier of form for each reporting year. Or go to <br />hire -wren cdphe suers « n as'wq pennrnt tnrttrrnmrK•Ylrr tm/nraral hprtl J �.} Check if this is a <br />9J (f, 6 new name, address, etc <br />Permittee (Company Names ��G�"j_l. t' �" iJ� ti' 'L%, ;E v'� o <br />Facility Name _— v ° f (I i'Y y(i . ' rr., j —.� \i j Jac t r.1 �r l r !'' Q <br />Mailing Address. <br />Facility Phone \umbra '(` S S_ • -_—_--___-..._- --- _ _ _ , r ` — — O <br />Permit Certification No ('OR -34 �f 2-y: - Sl - COG -50 <br />(rWrnxn<e c.nfacsiNe onW) tMarinwarr.�d proaer Ire a. ralnaed t.ndic.rWY• <br />Reponmp Pennd lin I Der: 1 )n —t (Form i ,Jur b't Fell l i u/ do /dhrwrng year) <br />• ^Each section mutt be completed. Please print or type. - <br />A. <br />A. A rrryut an dee /aeday's rreerrd( comphunrr inch the Stf ul' (Include here d summary of any measures tdken <br />to comply with your Stormwam Management Plan (SWhtPl, to fulh implement it, changes or improvements <br />made in any mfyour Hest Management Practices (HMPs) employee training spills, other problems <br />encnnntered, etc How is your plan waking') <br />< r< r,F' <br />R ere cltangt's made to vour S WMP'' /Fl No 0 Yes - Describe changes on a separate sheet <br />R 4 .cummdry uJ ea. h coaryrreircran a r!arvrrnuler luairry reyrri n n m ries recto:/rrtg cute, [rruhnr.- end enter n <br />fuk rn ( fire pennit icgmrca at least two utmp+cheasivc fdcdny inspections per year -see page 8 of the permit <br />Include here a summary ofthose inspections, plus any other comprehensive inspections made It n not <br />necessary to summarim day-to-day inspections, unless significant problems were noted 1 <br />f,r, <br />Fist hts(teniun -Darr r .. .. !I•nndmgs, and attio+i taken <br />411 1" <br />Next - fmm ,nav be reprurimeJ Page i of <br />.r <br />} <br />STORMWATER ANNUAL REPORT. -SAND AND GRAVEL <br />Permit Cert. No_ COR34/COC-50 <br />Second Inspccnnn - Date _•'_t, hmdmgs, and action taken <br />f <br />Other inspections - Date _ '_/ __ Findings, and action taken <br />C< Ile,idfa and imerprelda , of unv srormwaternnrnuormq J+tr(ormcd Allrrth seJwrate shaenvah the fah <br />rradn (Memronng is not a regnuement under the penmi, tales you were specifically directed ru do co by <br />the Divnion I low ever, the results of any stomrwater monitoring that ycut performed on Your own should he <br />reported here ) <br />Slunuormg Rcoulta Atrdched'r y J no Dyes <br />D_ Cerirficsfinn <br />"I cendy under pertalty of law that this document and all attachments were prepared under my direction or <br />saperrtsmm in acamdancewtth a systian designed ro assure that qualified personnel pioperly gather and <br />evaluate the mkwmation submitted Based on my inquiry of rte person or persons who manage the systran ru <br />those person; rhimliv responsible for gathering the information, the information submitted is, to the bast of nhy <br />knowledge and Whit, true- accurate and complete I ant aware that thereare rtgrnficant penalties lir <br />submitting false nrf,+rniatiun. including the possibility of tore and imprisonment for knotting vtolations " <br />Srgnatuie t+t PCrmatee (legally revpon,oble pemdn) -r Y�--- — Date %limed <br />Nanne(prnls.l) <br />tiw adda",[ pages ai nc,&J p4g,, .d ' <br />