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7.Other Faviromoeetal Permits: Don this ~y emremly have and cmvammesmai peaoits„ as is it stdrjeetto <br />mgulatioq uada arry of the following programv7 <br />No Yes Pemric <br />a) Colorado Discharge Permri Syscern (COPS or NPDES) ~1 _`~ <br />b) Resource Cwaervatim and Recovery Ad (RCRA) ~[,~ __ ! <br />c} Colorado Diviuan of Minerals and Geology (fomteriy MLRD) _~,~ Sundav M-77-285 <br />Topaz M-80-0SiHR: Carnation M-77-416: St Jude M-18-OSSHR_ Burro M-77-297. <br />d) Superfund Ameadme~ sad Rrauthori>ation Act(SARA), Title III <br />(Emergmey Plaaniag sad Cotmmmity Right4o-Know Act), Seedon 313_ j ,_, __ ' <br />If Yee , is the fadlity subject to reporting toquirearczus for I; circle applicable} <br />airy watt priority chemicals under SARA Title III, Sation 313 ? ~ ,, Chanicals is Appcodix A) <br />8. Group Applicants: Are you eu:rtntly partiaparing in a stormwater group application +Hith. EPA7 <br />_No _~Ya Group Application Numbs 569 <br />9. SPECIAL REQUIREMENT Stormw+ater Management Plan <br />a) Light industrial facilities, and metal mining fieilitin: for new faalioies (begiming operations after October 1, <br />1992), or existing facilities applying after May 1, 1993, a Stormwater Maoagemrat Plan (SWMP) shall be <br />Prepared prior to applying for wverage under the general permit, and the following axrification signed. Sa <br />Appendix C of the application for a listing of naoessary SW[vIP requiraaems. " <br />"I terrify undo penalty of law thaz a crnrtpide Stormwater Managaaem Plan, in cam~plianee with Appendix C of ~ <br />the sppGcation, has ban prepared for mY facility. Based as my inquiry of the person of petsoat who roanagc <br />the systeati or those persons dira;rly responsible for gathering the informatiaq the SWMP u to the beat of my ' <br />Imowiedge sad belie!; true, accuratrti and casnplete. I am aware that there are significam penalties for falsely <br />certifying the completion of said SWMP, including the possibility of 5oe a~ imprisonatent" <br />NA , <br />Signature of Permit AppGnm Date Signori <br />Name (printed) Title <br />b) Heavy indtrstrial facilities: for nett' faciliries (beginning operations after October 1., 1992). or existing facilities' <br />applviag after June 1, 1993, the permitter shall submit a completed SWMP to the Division with the permit <br />application. Sa Appendix C for a listing of naasary items under this requirernem_ ' <br />SWMP enclosed ~,~No _,Yes <br /> ' <br />10. Signature of Applicant <br />"I certify under penalty of law I have personally examined and am familiar widr the information submitted in <br />this application and all attachment sad that, based on my inquiry of those individuals i+*~+~I~*~ty responsible for <br /> <br />obtaining the infiocmation, I believe that the information is true, accurue and rnmplete:. I am aware there are , <br />significant penalties for submitting false it-formation, including the possibility of fine a~ irrtprisonmeat." <br />~~i;o I92 ' <br />Si®nature of Applicam Date Signori <br />Richard A. VanHom. Ditectnr of Oneratiom ' <br />Name (primed) Tide <br />2 ' <br />P~ <br /> <br />