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FOR AGENCY USE ONLY COAL MINING 'PERMIT NUMBER PROCESS WATER AND STORMWATER DISCHARGE APPLICATION I DATE<REt:&ISrED YfiAR I MONTH I DAY PLEASE PRINT OR TYPE Do not attempt io complete this form before reading the aceompanying instructions. New ~ or Renewal ^ If renewal, existing permit number. CO 050027 I. Name and Address of Operator: Company Name: OalQWge Energy. Inc Federnl Taxpayer (m Employer) IDN: 870287176 Meding Address: 4613 Jacbboro Highway City, State and Zip Code: Wiehih FaBa, Tezas 76302 Phone Number. (9401 322 4772 Who u applying fm the permit? X ~ Operator Local Contact (familiar with faciL'ty): Brvan Duff. P.E. Titre: Resident Agent, Goff Enginaring and Sarveyiog Phone Number. (97012471705 Feat No.: (9701 2471710 Compliance Contact (familiar with facility): Michael S Sawce ~ Title: Prhtcipal, Swage and Savage, Ina Phone Number: (3031666 7372 Fax No.: (3031 665 6508 2. Name and Address of Owner. Name: Oaluidge Energy, ins Mailing Address: 4613 Jael®boro Highway City, State and Zip Cade: R'khih Fags, Tens 76302 Phcee Number. (9401 322 4772 Fax No.: (9401322 9452 3. Loatbn o[ the FaeBity: Street Address: Ewing Mena, two mBes south of Durango City, Strata and Zip Code: Durango, Cobndo 81301 County: I.a P4M Name of fecitity : Carbon Jancdon Mine Legs) Location (Township, Rangq sation,l/4 cation): Suction 4 T34N, R9W, Setfion 33, T34YaN, Lt9W, and Sectim 33, T35N,119W Latitude and Longitude: 35°15'00" N, 107°51'20" W 4. Cotporale Strnetare: Please provide, on a separate shat, the corporate sltuctme(s) for those companies Gsted m items ]and 2. The atructwe should exhad b the ultimate parent company. In the case of a joist ventrm, please provide this infom~ation for each company which is part of thejoint venture, as well as ownership interests. Sa Attached _ . 5. Standard industrial Classlflcation (SIC) Code(s) fm this facility. (Include up to four, in order of importance J e) 1221 b) c) d)