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MAY/12/2017/FRI 05: 04 PM FAX No, P, 003 <br /> 4- Sbuti and Ind¢sbW C assMea6m(SIC)Code(s)far this facility_ (Tt da&up to four,w order of importance.) <br /> a) 1442 b) o) d) <br /> S. Receiving Stream: The name of the zeceivkg siream(s).(If discharge is to a ditch or storm newer.also uaclade the name of <br /> the ultimate receiving water) <br /> THE HIGHUNE CANAL WILL BE THE FIRST RECEIVING DITCH, IF THE DITCH OVERFLOWS THE <br /> ARKANSAS RIVR IS THE NEXT RECEIVING BODY (RIVER) OF WATER. <br /> 6. Describe the indushial aedyides whkh take glace on site. <br /> Sand & Gravel Extraction & Processing <br /> I. ether Enviftnmentstl rtrmifs: Does tt s facUity cm-nmtly have any envtt permits,or is it subject to regulation, <br /> tmder either of fie following programs? <br /> Na Yes peit � <br /> a)Colorado Dwharge Permit System(CDPS or NPD <br /> b)Colorado Mined Land Reclamation Board. _ xx _M 2006-081 <br /> If Yes,inch&MLRB permit amtivwsary date MARCH 2O07 <br /> 8. S ORMWATER MAMMMU 1VT PLAN <br /> A Stomwater Management Plan(SVAe)shall bep+tp wWprior to a"Mcaam for wverage ender a general permit,and the <br /> following certificoon signed. See tie SWW req=ements in Appel A. <br /> "i certify MdW penalty Of law&at a complete Stommai er Management Pk m,in corapbance widL Appendix A of the <br /> application,has been prepared for mar faa"lity. Based on my inquiry of the pmm or persons who nnanage the system,or <br /> those persons directly responsible for gadwriDg the mformation,she 9WMP is,to the best of my k owledge and belief,true, <br /> accurate,and complete. I ant aware that there are significant pewhies for falsely antifying the completion of said SWMP, <br /> including tie possibility of fine and imprisotumemt- <br /> of Applicant Date Signed <br /> DANIEL J. GAUDREAULT OPERATOR/OWNER <br /> Name(panted) Titre <br /> 9.Siege dwe ofAp)pheant(legally regpona9ble person) , <br /> "I certify under penalty of law that I have personally eaami ed and am famili want the information submitted in this apphcatiou <br /> and all attachments and that,based on my mquay of Bose individuals immediately responsible fair obtaix ft the hAbrmatkm,I <br /> believe that the information is true,acc ua to and caa;plete. I am aware that there are significant penalties for awing false <br /> heron than,including'the possibility of five and mpris;oment." <br /> a — C3 <br /> gC6 of PRQAppiicant Date Signed <br /> DANIEL J. GAUDREAULT OPERATOR/OWNER <br /> Name(printed) Title <br /> 7193l59 -7r <br />