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<br />" 4. Industrial di~a rges (industries, mines, gravel pits, w~ treatment plants, <br />etc.) <br />A. Description Of facilities Gravel plt <br />9. Principal product or raw material Sand and gravel <br />C. Maximum amount of principal product produced or raw ma feria{ consumed <br />per day 500 tons <br />D. Check [he month(s) [he discharge occurs. <br />J Q F~ M ® A© M® J© J® A©$® 0® N® 0 Q <br />E. Unit treatment Drocesses utilized Settling Pond <br />F. Number of discharge poincs One <br />NQQrthea$$t corner Qpf ppopperty <br />G. Description of discharge loca[ion(s):(See DhOtO iHdD dtLdChed l• <br />H. Name of receiving water(s) Big Thompson River <br />1. Is land application used or planned? NO <br />J. Attach any labo ra [o ry analyses of your effluent quality n/d <br />5. Additional info rma[ion (sketches, etc.) <br />I certify that I am familiar with the information contained in the application and <br />that to [he best of my knowledge and belief such information is [rue, comple [e, <br />and accurate. Please review siyna [u re of applica[i on on instruction sheet before <br />lignin <br />Printed Name of Person S,,i g'n7i ng ~,~ /n/ `[,~~ <br />) .C~c--J L-CJ 112~C1 iL.iK~ <br />z <br />Title <br />Dale Application 5 <br />Signature of Applicant <br />