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CDFHE ',10Cp i.< - - tar <br /> _fiQQ 11_::1% r. Ufl <br /> GZ ESL ? AP?T.7QTaOr7 :OR !(3aMCY USE ONLY <br /> STORTAW-A&T iR DISCHARGES C'armfimdon Number <br /> ASSOCIATED WMA I <br /> SAND AND GRAVEL FRODUCT-TON <br /> OFERATMONS uAND 01 Dau 3ectived ree Category i <br /> NONMETALLIC <br /> :HZ.KC.EI>T FUEL) <br /> Year Momrh �7, ! <br /> -permit . COG-�gOCAp) <br /> Please print or type. Do not attempt w complete this form before reading the instructions. <br /> 1. Is this the correct applicatiou for your facility"? This application is only for the discharge of 5tormwater. <br /> Do you discharge any of the following process generated wasxewatem from your tacuity? <br /> No ❑ Yes Product waslt waters <br /> L J No ❑ Yes -Mainrenxnce/equipment wash -Naters <br /> No ❑ Yes Transport waters (e.g-, slurries) <br /> � <br /> ❑ No ❑} Yes Scnhbber weer (crushers or C:assiiiers) <br /> 1 ! No � Y Aine dewarering (groundwater and/or nmoir from the mine) <br /> If you answered Yam, to any of these questions, do not complete this application. You must instead ramplete the <br /> Fracess Water end Storaiwater DU hnrgves Assodated wlth Sand and Craved application for this fatuity, which is <br /> avaiiable from the Division. <br /> Name and address of permit applicant: <br /> Company Name: Iield County Public Works <br /> Federal Taxpayer (or mpiovei) ID#: i 6 0 0 0 8 1 3 <br /> Maiiing Address: P.O. Box 758 <br /> City, State and Zip Code: Greeley, CO 80632 <br /> Phone Number ( 970 ) 356-4000, R3750 Who is applying ipr the permit? ❑ Owner ❑ Operator <br /> Local Contact (familiar with facility): Greg Nelson <br /> Title: Mining Supervisor Phone Number: ( 970 ) '356-4000, Ext. 3750 <br /> Location of the facility: <br /> StreetAddresss: WCR 13 approximately 1/2 mile south of WCR 62, east side of WCR 13 <br /> City, State and 7Ap Code: Windsor. CO <br /> County: Weld Name offwility: Lind Borrow Pit <br /> Legal Location (Township, Range, section, 1/4 section): Sec . 6, T51NT. R67W, SW 1/4 <br /> Latitude and Longitude. Tat, 40 25' Lone. 104 55' <br /> Type of FacRity: ❑ New (begmaing operations after io/1/92) ❑ Emsung (as of 10/1/92) <br /> '3lgq _1_ <br />