Laserfiche WebLink
4. Standard Industrial Classification (SIC) Code(s) for this facility. (Include up to four, in order of importance.) <br />a) 141(1 b) 1442 c) 1440 d) <br />5. Receiving Stream: The name of the receiving stream(s). ([f discharge is to a ditch or storm sewer, also include the name of <br />the ultimate receiving waters.) WE have Piped the Bray Ditch. The ultimate <br />receivit>g waters -Arkansas River <br />6. Describe the industrial activities which take place on site. <br />Construction of the river access road will be in 4 phases. Material will be screened <br />anti rwnnvPri frrm the ai tP. Ml1PYlal G will also be used on site for landscapirt~_ <br />7. Other Environmental Permits: Does this facility currently have any environmental permits, or is it subject to regulation, <br />under either of the following programs? <br />a) Colorado Discharge Permit System (CDPS or NPDES) <br />b) Colorado Mined Land Reclamation Board <br />If Yes, include MLRB permit anniversary date <br />8. STORMWATER MANAGEMENT PLAN <br />X <br />g Tn nrcx~PSs <br />A Stonnwater Management Plan (SWMP) shall be prepared prior to application for coverage under a general permit, and the <br />following certification signed. See [he SWMP requirements in Appendix A. <br />"I certify under penalty of law [hat a complete Stormwater Management Plan, in compliance with Appendix A of the <br />application, has been prepared for my facility. Based on my inquiry of the person or persons who manage the system, or <br />those persons directly responsible for gathering the information, the SWMP is, to the best of my knowledge and belief, true, <br />accurate, and complete. I am aware that there are significant penalties for falsely certifying the completion of said SWMP, <br />including the possibility of fine and imprisonment." <br />Signature of PeZrrrif Applicant <br />Date Signed <br />VUN tTOI.t.EnlgEr-IL 1"I~CbIOI-nIr <br />Name (printed) Title <br />9. Signature of Applicant (legally responsible person) <br />"I certify under penalty of law that I have personally examined and am familiar with the information submitted in this application <br />and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I <br />believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false <br />information, including the possibility of fine and imprisonment." <br />Signature of <br />Date Signed <br />TN k-~0t,t.ENQEC{c `~}~(Z~stD2T1T <br />Name (printed) Title <br />7/93/sg -2- <br />