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COAL MINING PROCESS WATER AND STORMWATER DISCHARGE APPLICATION FOR AGENCY USE ONLY PERMIT NUMBER 0 DATE RECEIVED YEAR MONTH DAY PLEASE PRINT OR TYPE Ib not attempt to complete this form before reading the accompanying instmctions. New ^ or Renewal IGy If renewal, existing pemrit number: CO G-850042 1. Nance and Address of Operator. Company Name: Oslnidge Energy, Inc. Federal Taxpayer (or Employer) IDk: 870287176 Mailing Address: 4613 Jacloboro Highway City, State and Zip Code: Wichita Fags, Tezss 76301 Phone Number. (9401 322 4772 Who is applying for the pernit7 X ~neL Operetor Local Contact (familiar with facility): Brvsn DutL P.E. TiOe: Resident Agent, Goff Engineering end Surveying Phone Number: (970 1 247 1705 Fax No.: (970) 247 1710 Compliance Contact (familiar with facility): Michael S. Savsee Title: Principal, Savage sad Savage, Inc Phone Number. {9701674 8080 Fex No.: (9701 674 8088 2. Name and Address of Owner. Name: Oslnidge Energy, Inc Mailing Address: 4613 Jaclaboro Highway City, State and Zip Code: Wichita Falls, Tezas 76302 Phone Number. (9401 322 4772 Fns No.: (940) 322 9452 3. Location of the Facility: Street Address: Ewing Mesa, two miles south of Dorongo City, State and Zip Cade: Durango, Colorado 81301 CounTy: La Plata Narme of facility : Carbon Junction Mine Legal Location (Townshiq Range, section, 1/4 section): Section 4 T34N, R9W, Section 33, T34XN, R9W, and Section 33, T35N, R9W Latitude and Longitude; 35°15'00" N, 107°51'20" W 4. Corporate Struchtre: Please provide, on a separate sheet, the corporate structure(s) for those companies fisted in items 1 end 2. The structure should extend In the ultimate parent company. 1n the case of ajoint venture, please provide this information for each company which is part of thejoint venture, as web as ownership interests. See Attached 5. Standard Industrial Classtfiwtinn (SIC) Code(s) for this facility. (hrclude up to four, in order of hnportanceJ a) 1221 b) c) d)