Laserfiche WebLink
COG500000 Permit Application www.coloradowaterpermits.com <br /> B. CONTACT INFORMATION <br /> 1. Permittee Information <br /> Organization Formal Name: <br /> Permittee Name: the person authorized to sign and certify the permit application. This person receives all <br /> permit correspondences and is responsible for ensuring compliance with the permit. <br /> Responsible Position (Title): Owner/Operator <br /> Currently Held By (Person): George L. Quist <br /> Telephone No:719-337-2067 <br /> Email address: gquist@hotmail.com <br /> Mailing Address: 1849 Trail Creek Road <br /> City: Lake George State: Colorado Zip: 80827 <br /> This form must be signed by the permittee to be considered complete. Per Regulation 61, in all cases, it shall <br /> be signed as follows: <br /> a) In the case of corporations, by a responsible corporate officer. For the purposes of this section, the <br /> responsible corporate officer is responsible for the overall operation of the facility from which the <br /> discharge described in the application originates. <br /> b) In the case of a partnership, by a general partner. <br /> c) In the case of a sole proprietorship, by the proprietor. <br /> d) In the case of a municipal, state, or other public facility, by either a principal executive officer or ranking <br /> elected official. <br /> 2. DMR Cognizant Official (i.e. authorized agent)the person or position authorized to sign and certify reports <br /> required by permits including Discharge Monitoring Reports [DMR's], Annual Reports, Compliance Schedule <br /> submittals, and other information requested by the division. The division will transmit pre-printed DMR's to <br /> this person. If more than one, please add additional pages. <br /> o Same as 1) Permittee <br /> Responsible Position (Title): Owner/Operator <br /> Currently Held By (Person): George L. Quist <br /> Telephone No: 719-337-2067 <br /> Email address: gquist@hotmail.com <br /> Organization: George L. Quist <br /> Mailing Address: 1849 Trail Creek Road <br /> City: Lake George State: Colorado Zip: 80827 <br /> Per Regulation 61: All reports required by permits, and other information requested by the Division shall be <br /> signed by the permittee or by a duly authorized representative of that person. A person is a duly authorized <br /> representative only if: <br /> a) The authorization is made in writing by the permittee <br /> b) The authorization specifies either an individual or a position having responsibility for the overall <br /> operation of the regulated facility or activity such as the position of plant manager, operator of a well <br /> or a well field, superintendent, position of equivalent responsibility, or an individual or position having <br /> overall responsibility for environmental matters for the company. (A duly authorized representative may <br /> thus be either a named individual or any individual occupying a named position) <br /> c) Submitted in writing to the Division <br /> Page 2 of 8 - Revision 2/2021 <br />