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-INSTRUCTIONS- WATER QUALITY CONTROL DIVISION COLORADO DISCHARGE PERMTI' SYSTEM PROCESS WATER and/or STORMWATER COAL MINING DISCHARGE APPLICATION This form may be reproduced. For information on electronic copies, please contact the Permits Unit at (303) 692-3500 This application is for use by aU coal mining facilities with process wscer and/or scermwacer discharges. It is applicable for both general and individual permit coverage. The Division has other industry~pec:ific permits htcluding: sand & gravel mining, coostrurtion dewatering, gasoline clean up sites, water treatment pL hardrock mhting/mi0ing, placer mining and minimal distitarge. If the Cacdity fa0s under one of these activities, pinase contact the Division for Ote appropriate application instead of this application. WATER RIGHTS The Stale Enguteers Office (SEO) has atdicared that any discharge that does not retain water dhecrly to surface waters (ie. land application, rapidmfdtration ba etc.) has the potential for nmterial injnry• m a water right As a resu8, Ore SEO nceds m determine that material hyury to a water right wi0 no[ occtu from such activities. To make this judgement the SEO requests that a Dopy of all do~trrnrntation demonstrating that the requirernenfs of Colorado water law have been me submitted to theQ office for review. The submittal should be made as soon as possible to the followarg address: Cobmdo Division of Water Resources 1313 Sherman Street, Room 818 Denver, CO 80203 Should there be any questions on the issue of water rights, the SEO can be contacted at (303) 866-3447, M-F, 10.110 am - 330 pm. h is hnportant m understant any CDPS permit issued by the Division does not eoustidrce a weer right Lssaance of a CDPS permh does not negace the need ce also have the oecesasr water rights io place. h is also intportant to understand that even if the activity has an existatg CDPS pemti; there is no guatantce that the proper water rights in place. GENERAL INSTRUCTIONS Application Due Datea: At least oae hundred sad eighty {180) days prior to the anticipated date of discharge for new facilities or the expiration date of an existing permB, the owner (or operator if the owner does not operate the faa7ity) of the facduy sha0 submit an application as provided by the Water Quality Cont Division (the "Division"). Permit Fee: Annual permit fees set by state statute and are colleted by the Divison. Do not send anv oavment witlr [Iris almfication. You will be b01ed once N are covered under a permit Effective July 1, 1998, them is aho a fee for permit amrndmentc Application Completeness: All items of the application must be oomple[ed accurately and in they entirety or the application will be deemed'mcompkte, and processing of the perm& wdl not begin unnl all information is received Tf you have questions on completing this appfitttion, you may contact the Division a[ (31 692-3500. The original and two copies of dte oompleced application shall be submitted only to: SUBMIT APPLICATION TO: Coorado Department of Pablie Health and Eovirooment WQCD-P-B2 4300 Cherry Creek Drive South Deuveq CO 80246-1530 SPECIFIC INSTRUCTIONS (Use additional pages whenever necessary) Item 1 - Lis[ here the names(s) of the person, company, corporation, etc who will be responsrbk fm the permit Item 2 - List here the owner ofthe property if rt is different than that (isledm item (. Item 3 - Self explanatory. Item 4 - Provide a discusson or an organizational chart which lists the corporate structure of those companies which opemte the facility or own the mineml rights or property from which the discharges covered by this perm@ originate. The discussion should extend to the ultimate parent company of ear company listed. Item 5 - The Standard Industrial Classflication (SIC) Code for the facility must be listed SIC Codes are assigned according m the primary activities perforo by a company. They are often assigned for insurance purposes or when a bushress registers as a mrporation. Industries can also determine theh SK