2016-08-08_PERMIT FILE - M2016041

• Permit No: M2016041
• IBM Index Class Name: PERMIT FILE
• Doc Date: 8/8/2016
• Doc Name: Application
• From: Ames Construction, Inc.
• To: DRMS
• Email Name: PSH
• Email Name: ECS
• Email Name: WHE
• Media Type: D
• Archive: No

STATE OF COLORADO For Agency Use Only
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Permit Number Assigned
• •
Dedicated to protecting and improving the health and environment of the people of Colorado •
COR03-
Water Quality Control Division • Date Received—J—J
4300 Cherry Creek Drive South
WQCD-WQPS-B2
Denver,CO 80246-1530
(303)692—3500 www.coloradowaterpermits.com
COLORADO DISCHARGE PERMIT SYSTEM (CDPS)
STORMWATER DISCHARGE ASSOCIATED WITH CONSTRUCTION ACTIVITIES APPLICATION
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-WQPS-B2
Denver,CO 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.
HOW TO COMPLETE THIS APPLICATION
1.Online via web browser.You must use Internet Explorer(version 8 and above).All other browsers disable the electronic submission features.
OR
2.Download and save this form to your computer.Then open Adobe Reader(or Acrobat),select File,then Open and navigate to where the form is saved.This is the best
option if using a Mac computer(Do not use the Mac Preview program).
PERMIT INFORMATION
Reason for Application: NEW CERT ❑ RENEW CERT EXISTING CERT#
Applicant is: ❑ Property Owner ❑✓ Contractor/Operator
A.CONTACT INFORMATION—NOT ALL CONTACTS MAY APPLY*indicates required
*PERMITTEE(if more than one please add additional pages)
*ORGANIZATION FORMAL NAME: Ames Construction, Inc.
1)*PERMITTEE CONTACT the person authorized to sign and certify the permit application.
This person receives all permit correspondences and is the person responsible for ensuring compliance with the permit.
Responsible Person(Title): Senior Vice President
Currently Held B (Person): FirstName: Robert Gillis
y( ) LastName:
Telephone: [phone] Email Address: [e-mail]
Organization: Ames Construction, Inc.
Mailing Address: 18450 E. 28th Ave
City: Aurora State: Co zip Code: 80011
This form must be signed by the Permittee(listed in item 1)to be considered complete.
Per Regulation 61 In all cases,it shall be signed as follows:
In the case of corporations,by a responsible corporate officer. For the purposes of this section,the responsible corporate officer is
responsible for the overall operation of the facility from which the discharge described in the application originates.
In the case of a partnership,by a general partner.
In the case of a sole proprietorship,by the proprietor.
In the case of a municipal,state,or other public facility,by either a principal executive officer or ranking elected official.
SW Construction Application for: Ames Construction,Inc.06/15/2016 page 1 of 5