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The name of the receiving waters(s). (If discharge is to a ditch or storm sewer, also include the name of the ultimate <br />receiving water): <br />Deadman's Gulch - Intermittent tributary to the Lake Fork of the Gunnison <br />Describe the industrial activities which take place on site. <br />Seasonal under round minin for old <br />Some onsite ore crushin with associated waste rock roduction <br />Stormwater Management Plan Certification: A Stormwater Management Plan (SWMP) shall be prepared prior to <br />applying for coverage under a general permit, and the following certification signed. See SWMP requirements in <br />Appendix B. <br />"I certify under penalty of ]aw that a complete Stormwater Management Plan (SWMP), in compliance with Appendix B of <br />the application, has been prepared for my faci]ity. The SWMP was prepared under my direction or supervision and with a <br />system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my <br />inquiry of the person or persons who manage the system, or those persons directly responsible for gathering fhe <br />information, the SWMP is, to th~~e,,~~ st f'~~' knowledge and belief, true, accurate, and complete: I am aware that there are <br />significant penalties forsQbmittyttg~~ ir3'formation, including the possibility of fine and imprisonment. <br />Person (submission must include original signature) Date Signed <br />Name (printed) <br />8. Signature of Applicant <br />Title <br />"I certify under penalty of law that I have personally examined and am familiar with the information submitted in this <br />application and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining <br />the information, I believe that t ~fon anon is true, accurate and complete. I am aware that there are significant <br />penalties for subn37ttfals f rm~ on, including the possibility of fine or imprisonment. <br />of Legally~es~nsible Person (submission must include original signature) Date Signed <br />Name (printed) <br />Title <br />5/07/MM ~ 2 oft <br />