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<br />PROCESS WATER, STORMWATER AND GROUND <br />WATER <br />DISCHARGES FROM INDUSTRIAL WASTEWATER <br />FACILITIES <br />c <br />Pkax print or type. Ian not attempt to compkfe this form before trading the instructions. <br />New ®ot Rrnewal ^ ifrenewel, existing permit number. CO-00 <br />Name and addrssa of permit applicant: <br />Company Neme: ~Ow l ~ 2cS o~ 2CL5 t,l M t'[ti D <br />Fedcnl Taxpayer (or Employer) IDtl:~+ 4 I 2 ~+ 1 ~ ~ <br />Mailing Address : Q - d ~G>fi '4' `(3 <br />City, State end Zip Code: ~Ar•~titn. CO f~14Z~', <br />Phone Number :(Q'1J1 5Z7-'1.135 Who is applying for the pertnil7 ©Owncr ^ Operator <br />heal Confect (femilisr with Caeility): a As 1 L $EA t2-- <br />Tige: E:NV t2o..t tJ~3wT0. ~ Phone Number: 01101 c,L~l - 2 L7 b Psx No.: <br />Co a(LL~ r.~?~.~ 2 X1-1 u - 5L 1 - L Z 3 `-~- <br />Name and address of property owner. <br />Name: ~PPI.r C AN T"- <br />Mailing Address <br />City, Stele and Zip Codc <br />Phone Number:( ) Fax No.: <br />3, Locatbo of the 6c(llty: <br />titrwfAddrcw: ~L~ S'CATG ~1Cn1{rJA`! (33 5 1d(tr_CS NG OF 1~'AoNrA Cp _ <br />Cily, State and Zip Code: ~W t C ~ CO B 14 Z 8 __ <br />County. l~Et-'TA NemeoCfacility: ~t'`~t~' ~J L Mlar <br />Legal Loeation (township, Range, section, I/4 section): T' 13 S s R 4 1 ~ j 5~c C ~ . i S hl ~_- ~~{" <br />o ~r o <br />Latitude and Longitude: E f3 'S~~ ~ / ~+ I U~ 31 . Z ~ •• <br />4. Standard IndusMd Classification (SIC) CWe(s) for this ficility, (Include up b (our, in order of importance.) <br />a) ~ ~ b) c) <br /> <br />