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GENERAL PERMIT APPLICATIGA FOAGENCY USE ONLY <br /> STORMWATER DISCHARGES <br /> Certification Number <br /> ASSOCIATED WITH71 <br /> dhND AND GRAVEL PRODUCTION C O G - 5 0 <br /> 1pERATIONS (AND OTHER Date Received Fee Category <br /> NONMETALLIC MINERAIS <br /> EXCEPT FUEL) Year . Month Day <br /> (Permit No. COG-500000) <br /> Please print or type. Do not attempt to complete this form before reading the instructions. <br /> 1. Is this the correct application for your facility?? This application is only for the discharge of stormwater. <br /> Do you discharge any of the following process generated wastewaters from your facility? <br /> X❑ No ❑ Yes Product wash waters <br /> R1No ❑ Yes Maintenance/equipment wash waters <br /> X❑ No ❑ Yes Transport waters (e.g., slurries) <br /> ® No ❑ Yes Scrubber waters (crushers or classifiers) <br /> 50 No ❑ Yes Mine dewatering (groundwater and/or runoff from the mine) <br /> *Process <br /> you answered Yee to any of these questions, do not complete this application. You must instead complete the <br /> Process Water and Stormwater Discharges Associated with Sand and Gravel application for this facility, which is <br /> available from the Division. <br /> 2. Name and address of permit applicant: <br /> Company Name: WAN SLOPE FLAGSTONE <br /> Federal Taxpayer (or Employer) ID#: 84 0 9 8 0 4 7 1 _ <br /> Mailing Address: 3316 E 3/4 Road <br /> City, State and Zip Code: Clifton, CO 81520 <br /> Phone Number: ( 970 ) 434-7948 Who is applying for the permit? ❑}{ Owner ❑ Operator <br /> Local Contact (familiar with facility): Rudy Fontanari <br /> Title: Owner Phone Number: ( 970 ) 434-7948 <br /> 3. Location of the facility: <br /> Street Address: NONE <br /> City, State and Zip Code: Cameo, CX) <br /> County: Mesa Name of facility: WESTERN SLOPE FLAGSTONE QUARRY NO. 2 <br /> Legal Location (Township, Range, section, 1/4 section): SW; SW; Section 35 T1 OS R98W 6th P.M. <br /> Latitude and Longitude: 390 08' 11 .45" 108° 18' 16.11" <br /> • Type of Facility: ❑ New (beginning operations after 10/l/92) ❑ Existing (as of 10/1/92) <br /> 7/93/ag -I- <br />