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

2) DMR COGNIZANT OFFICIAL(i.e.authorized agent)the person or position authorized to sign and certify reports required by the Division
including Discharge Monitoring Reports*DMR's,Annual Reports,Compliance Schedule submittals,and other information requested by the
Division.The Division will transmit pre-printed reports(ie.DMR's)to this person.If more than one,please add additional pages.
❑ Same as 1)Permittee
Responsible Person(Title): Project Manager
Currently Held By(Person): FirstName: Dustin LastName: Williams
Telephone: [phone] Email Address: [e-mail]
Organization: Ames Construction, Inc.
Mailing Address: 18450 E 28th Ave
City: Aurora State: CO Zip Code: 80011
Per Regulation 61:All reports required by permits,and other information requested by the Division shall be signed by the permittee or by a duly
authorized representative of that person.A person is a duly authorized representative only if:
i. The authorization is made in writing by the permittee.
ii. The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or
activity such as the position of plant manager,operator of a well or a well field,superintendent,position of equivalent responsibility,or an
individual or position having overall responsibility for environmental matters for the company.(A duly authorized representative may thus
be either a named individual or any individual occupying a named position);and
iii. The written authorization is submitted to the Division.
3) *SITE CONTACT local contact for questions relating to the facility&discharge authorized by this permit
❑ Same as 1)Permittee
Responsible Person(Title): Project Engineer
Currently Held By(Person): FirstName: Brodie LastName: Parsons
Telephone: [phone] Email Address: [e-mail]
Organization: Ames Construction, Inc.
Mailing Address: 18450 E 28th Ave
City: Aurora State: CO Zip Code: 80011
4) *BILLING CONTACT if different than the permittee.
❑ Same as 1)Permittee
Responsible Person(Title): Office Manager
Currently Held By(Person): FirstName: Matt LastName: Blondke
Telephone: [phone] Email Address: [e-mail]
Organization: Ames Construction, Inc.
Mailing Address: 18450 E 28th Ave
City: Aurora State: CO Zip Code: 80011
SW Construction Application for: Antes construction,Inc.06/15/2016 page 2 of 5