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OR AGENCY USE ONLY <br />PERMTf NUMBER <br />COAL MINING <br />PROCESS WATER AND STORMWATER c o <br />DISCHARGE APPLICATION DATE RECEIVED <br />YEAR MONTH DAY <br />PLEASE PRONT' OR TYPE Do not attempt to complete this form before reading the accompanying instmctions. <br />New ^ or Renewal ^ If renewal, existing permit number. CO G-850027 <br />1. Name and Address of operator <br />Company Name: Osluidge EnergK Ina <br />Federal Taxpayer (or Employer) IDN: 870287176 <br />Mailing Address: 4613 Jactrsboro $ighway <br />City, State and Zip Code: Wichita Falls, Tezas 76302 <br />Phone Number: (9401 322 4772 Who is applying for the permit? X ~eG Operator <br />Local Contact (familiar with facility): Brvae butt P.& Title: Resident Agent, GoR Engineering and Surveying <br />Phone Number.19701247 1705 Fax No.: (9701 2471710 <br />Compliena Contact (familiar with facility): Michael S. Savaae Title: Prindpal, Savage and Savage, Ina <br />Phone Number: (303 1 666 7372 Fax No.: (3031 6656808 <br />2. Name wd Addrea of Owner. <br />Name: OalQidge Energy, Ina <br />Mailing Address: 4613 Jacksboro Highway <br />City, State and Zip Code: Wichita Falls, Terns 76302 <br />Phone Number. (9401 322 4772 Fax No.: (940) 3229452 <br />3. Location of the Facility: <br />Street Address: Ewing Mesa, two miles south of Dorango <br />City, State and Zip Code: Durango, Colorado 81301 <br />County: Le Plata Name of facility : Carbon Junction Mira <br />Legal Location (Township, Range, section, 1/4 section): Section 4 T34N, R9W, Section 33, T34'hN, R9W, and Section 33, T35N, R9W <br />LeUWde and Longitude: 35°15'00" N, 107°51'20" W <br />4. Corporate Stracturr: Please provide, on a separate sheaf, the corporate structure(s) for those companies listed yr items 1 and 2. The structrue should <br />extend to the uhimate parent company. In the case of a joint venture, please provide this infomration for each company which is part of the joint <br />venture, as web as ownership interests. Sa Attached <br />5. Standard Industrial Classifiea4on (SIC) Cade(sj for this facility. (Include up to four, in order of importarroe.) <br />a) 1221 b) c) d) <br />