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COG500000 Permit Application www.coloradowaterpermits.com <br />Page 7 of 8 – Revision 2/2021 <br />2.Are any of the receiving waters identified in the Table G.1 above a storm sewer system, ditch, or manmade <br />conveyance? <br />□Yes □No <br />Note: if discharge is to a storm sewer system, ditch, or manmade conveyance, approval from the owner of the <br />system must be obtained before discharge. <br />3.Did the applicant obtain approval from the owner of the storm sewer system, ditch, or manmade conveyance? <br />□Yes □No □ NA – discharge is not to a storm sewer system, ditch, or manmade conveyance. <br />H.CHEMICAL ADDITION/TREATMENT <br />If chemical additives, settling agents, flocculants, or other materials are proposed for use in or to treat <br />wastewater/stormwater prior to discharge, please submit a Chemical Approval Form with this application. <br />1.Is chemical addition/treatment proposed for this facility? <br />□Yes □No <br />2.Did applicant submit a Chemical Approval Form with this application? <br />□Yes □No - chemical addition/treatment not proposed <br />I.OTHER ENVIRONMENTAL PERMITS <br />Does this facility currently hold any environmental permits, or is it subject to regulation, under any of the <br />following programs? <br />Permit Name Yes No Effective Date Permit No. <br />1.Colorado Division of Reclamation, Mining and Safety □ □ <br />2.Underground Injection Control □ □ <br />3.Clean Water Act (CWA) Section 404 – US COE □ □ <br />4.Resource Conservation and Recovery Act (RCRA)□ □ <br />5.CDPS Stormwater □ □ <br />6.Colorado State Air Pollution Emission □ □ <br />7.Other □ □ <br />J.ACTIVITY DURATION <br />When did the activity commence? <br />What is the estimated life of the activity generating the discharge(s) ? years. <br />4 <br />4 <br />4 <br />4 <br />4 <br />4 <br />2026 <br />8