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Application for transfer of ownership for all permit,certifications and authorizations PART 1 pg 2 <br /> 1. NEW PERMITTEE INFORMATION (fill out all appropriate contacts) <br /> Responsible Position (title) Division Director <br /> Held by (person) Michael Cunningham <br /> Telephone# 303-866-3567 email address michaela.cunningham@state.co.us <br /> Organization <br /> (Should be <br /> same <br /> on pas age 1) Colorado Division of Reclamation, Mining and Safety <br /> Formal Mailing address Room 215, 1001 E 62nd Avenue <br /> City Denver State CO Zip 80216 <br /> 2. DMR COGNIZANT OFFICIAL (i.e. authorized agent) the person authorized to sign and certify the <br /> Reports as required by the permit, including Discharge Monitoring Reports (DMR's), Annual Reports, Compli- <br /> ance Schedule submittals and other information requested by the Division. The Division will transmit pre- <br /> printed reports (i.e. DMR1s) to this person. If more than one person, please add additional pages. <br /> This party may not sign application forms. <br /> Responsible Position (title) Project Manager <br /> Held by (person) David Tudor <br /> Telephone# 303-550-8961 email address dtudor@normservices.com <br /> Organization NORM Services <br /> Mailing address 6105 South Main Street, Suite 200 <br /> City Aurora State CO Zip 80016 <br /> 3. SITE CONTACT local contact for questions relating to the facility and discharge authorized by this <br /> permit for the facility <br /> Responsible Position (title) Site Manager <br /> Held by (person) Adam Billin <br /> Telephone# 775-299-1370 email address Adam.Billin@Iinkan.corn <br /> Organization NORM Services <br /> Mailing address 6105 South Main Street, Suite 200 <br /> City Aurora State CO Zip 80016 <br /> 4. CERTIFIED OPERATOR IN RESPONSIBLE CHARGE (ORC) may designate one or both if needed <br /> A. Wastewater Treatment Facility ORC <br /> Operator ID Number CWP-IA-01298-00117 <br /> Operator's Legal Name <br /> Patrick Delaney <br /> Organization NORM Services <br /> B. Wasterwater Collection System ORC <br /> Operator ID Number <br /> Operator's Legal Name <br /> Organization <br />