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EXHIBIT S I <br /> • F AGENCY "'SE <br /> �rlp_ICA710N ,NU,H3=R <br /> NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM D A = R= =:V=D <br /> APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM <br /> MUNICIPAL, INDUSTRIAL YEAR N0. DAY <br /> Do not attempt to comolete this form before readlna the accompanying Instructions <br /> Please print or type <br /> Name, aadress, and telephone number of the owner of the facility producing <br /> C:0 dl5cha rge. <br /> Q <br /> A. Owner Varra Companies, Inc. <br /> \! <br /> B. Facility name Varra Sand and Gravel <br /> ~cl) c. Mailing address 2130 S. 96th Street <br /> J <br /> CV :'E D. city Broomfield D. state Colorado <br /> i¢a E. county Boulder F. Zip Code 80020 <br /> 3 G. Telephone .`lumber ( 303 ) 666-6657 <br /> ZI Area Code <br /> 2. Location of facility <br /> A. Legal brief description NW 1/4 Sec. 31 T3N R67W <br /> B. Street 12906 Weld County Road 13 <br /> C. City NA 0. County Weld <br /> E. State Colorado <br /> F. Telephone Number ( 303 ) 447-2084 <br /> Area Lode <br /> G. Local contact Dick Allen or Vern Nelson (303) 356-6362 <br /> 3. Sanitary discharges (only for sewage treatment facilities) . Not Applicable <br /> A. Unit treatment processes utilized <br /> 3. Design flow (average daily) of facility MGD <br /> C. Percent BOD removal (actual-previous year] <br /> 0. Population served <br /> E. Number of discharge points <br /> F. Description of discharge lccat:cn(s) : <br /> G. Name of receiving water(s): <br /> H. Is land aoolication used or planned? <br /> 1. .Method of sludoe disposal <br /> J. (1) Do you receive industrial waste? <br /> (2) If yes, describe the sources <br /> K. Attach any laboratory analyses of your effluent duality <br />