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IIrA'FOrAI POLLUTANT DISCF:E~ ELIMINATION SYSTEM <br />APPLICATION FOR PERMIT TO DISCHARGE -SHORT FORM C <br />To fx filed only Dy persons engaged in manufacturing and Wining <br />~. <br />-__ i <br />,~ - <br />APPLICATION NUMBER <br />FOR , f{ <br />AGENCY ~ DATE"Rf`CEIVE~ <br />USE (~ <br />YEAR !D, 11AY <br />tiff' 1 ~ ?~l(1 <br /> <br />Do not attempt to coeplete this form before reading accanpanying tnstru_cttansMINED LA.f~~C R~i;LF,~ r'.r'~~,; <br />Ptease print or type ,, <br />Cr~r~. Derr!. ct ;,!,'_ •+ . . <br />1. Name. address, location. and telephone number of facility producing dlsclutrge <br />_ A, Name Mineral Conservation Area .No. 29 <br />B. Nailing address <br />1, Street address Brannan Sand and Gravel Co.; 4800 Brighton Boulevard <br />~ 2. City Denver ~ ~ 3. State Colorado <br />4, County Denver 5. Z1P 80216 <br />C. Locatlan: <br />1, Sireet___54uth of 132nd Avenue. betvreen Briohton Road and Nome Street <br />2. City approx. 5 miles SW of Brighton ~, County Adams <br />4, State Colorado ~ <br />D, Telephrne No, 303 534-1231 <br />- Area <br />Code <br />1. SIC <br />(Leave blank) <br />~. Humber of eagloyees Maximum of CO <br />If all your waste is discharged into a publicly rn:;:'d waste treatmen*. factltty <br />~.d to th? best of your S:r~owle.dge you are not r-:;~:;•~:d to :.~cain _ Lic::ars^ <br />permit. proceed to Item 4, Dtherwtse proceed directly to item 5. <br />4, Sf you meet the condition stated above, check here O and supply the information <br />asked for belor, After.compietfng these items, please complete the date, title, <br />and signature blocks below and return this form to the proper reviewing office <br />without colleting the remainder of the form. <br />A, Name of organization responsible for receiving waste, <br />B. factltty reutving waste: <br />1. Name <br />2. Street address <br />3. ctcy <br />0. County <br />5. State 6. ZiP <br />,~. XltPrincfpal product, grow material (Check one)-. In_150.000 tons of sand and gravel <br />1S, Princlpel process Excavate_ grade. crush, and stockpile <br />7, Maximum amount of prtncipai product produced or raw material consumed per (Check one) <br />Anaunt <br /> <br />Basis 1'99 <br /> <br />(1) 100.199 <br /> <br />(2) 200-499 <br /> <br />(3) 500-499 <br /> <br />(<) 1000- <br />4999 <br />(5) 5000• <br />9999 <br />(6) 10,000- <br />49,999 <br />(7) 50,000 <br />or anre <br />($) <br />A, Day <br />B. Month <br />C, Year XX 550,000 <br />i <br />i <br />i <br />ftFA F.... 73SO..a (R.v. 3-7J) n~[vrous [orrroM uwr s[ ueco uwTr~ au-~~v u exnwusr[m <br />