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5) OTHER CONTACT TYPES(check below)Add pages if necessary: <br /> Responsible Person(Title): <br /> Currently Held By(Person): LastName: <br /> Telephone: Email Address: <br /> Organization: <br /> Mailing Address: <br /> City: State: Zip Code: <br /> ❑ Pretreatment Coordinator ❑ Property Owner ❑ Compliance Contact <br /> ❑ Environmental Contact ❑ Inspection Facility Contact ❑ Stormwater M54 Responsible Person <br /> ❑ Biosolids Responsible Party ❑ Consultant ❑ Stormwater Authorized Representative <br /> ❑ Other: <br /> B) PERMITTED PROJECT/FACILITY INFORMATION <br /> Project/Facility Name Ames Const. Yard and Material Processing Area <br /> Street Address or Cross Streets 0.34 Miles South of the Intersection of Weld County Rd 49 &Weld County Rd 34 <br /> (e.g.,"S.of Park St.between 5th Ave.and loth Ave.",or"W.side of C.R.21,3.25 miles N.of Hwy 10";A street name without an address, <br /> intersection,mile marker,or other identifying information describing the location of the project is not adequate.For linear projects,the route of <br /> the project should be described as best as possible with the location more accurately indicated by a map.) <br /> city: LaSalle Zip Code: 80645 County: Weld <br /> Facility Latitude/Longitude -(approximate center of site to nearest 15 seconds using one of the following formats) <br /> ❑ Decimal Degrees <br /> OR 001A Latitude 001A Longitude (e.g.,39.703%104.933°) <br /> Degrees(to 3 decimal places) Degrees(to 3 decimal places) <br /> RDegrees,Minutes,Seconds <br /> 001A Latitude 40 o 13 39•h - 001A Longitude 104 0 36' 00mb • e.g.,39°46'11"N,104°53'11"W <br /> Degrees Minutes Seconds Degrees Minutes Seconds <br /> For the approximate center point of the property,to the nearest 15 seconds.The latitude and longitude must be provided as either degrees, <br /> minutes,and seconds,or in decimal degrees with three decimal places.This information may be obtained from a variety of sources,including: <br /> • Surveyors or engineers for the project should have,or be able to calculate,this information. <br /> • EPA maintains a web-based siting tool as part of their Toxic Release Inventory program that uses interactive maps and aerial pho- <br /> tography to help users get latitude and longitude.The siting tool can be accessed at www.epa.gov/tri/report/siting.jool/index.htm <br /> • U.S.Geological Survey topographical map(s),available at area map stores. <br /> • Using a Global Positioning System(GPS)unit to obtain a direct reading. <br /> Note:the latitude/longitude required above is not the directional degrees,minutes,and seconds provided on a site legal description to define <br /> property boundaries. <br /> C) MAP(Attachment)If no map is submitted,the permit will not be issued Facility Information <br /> Map:Attach a map that indicates the site location and that CLEARLY shows the boundaries of the area that will be disturbed.Maps must be no <br /> larger than 11x17 inches. <br /> D) LEGAL DESCRIPTION <br /> Legal description:If subdivided,provide the legal description below,or indicate that it is not applicable(do not supply Township/Range/Section <br /> or metes and bounds description of site) <br /> Subdivision(s): Lot(s): Block(s) <br /> OR ❑✓ Not applicable(site has not been subdivided) <br /> SW Construction Application for. Ames Construction,Inc.06/15/2016 page 3 of 5 <br />