Laserfiche WebLink
"_i;4 1j i: ::l�� <br /> 4. Standard Industriai C:assincation ?SILT Cade(s) for dais f.cihiry. (include ap m our, in order of importance.j <br /> a) 14110 b) c) d) <br /> 5. Receivir g,5tream: -Se name of the receiving, stream(s). 3f discharge is to a ditch or storm sewer, also inc'.ude the <br /> name of the uitfin to recdving wat=.) storm water retained on site and run-off into <br /> landowners reservoir on property <br /> b_ Desc'ibe the industr.al activities which take pi= on site. remove and_ stockpile fill material with <br /> self-loading scrapers. St.ockpiletimaterial load- into belly dumps with loader and haul <br /> to adjacent road project <br /> 7. Other Fnvirvumeutal Permits: Does this zacility currently have any euvironmenral permits, or is it subject to <br /> .eguiation, under either of the :allowing programs? <br /> NI O Yes permit X <br /> a1 Colorado Discharge permit System (CDPS or NPDE ) :{ _ <br /> b) Colorado Wiled lzud lterlamadom Hoard �, applied for <br /> If Yes include h4i.IiI3 permit anniversary date <br /> S. ST'OAMWA3'ER M&NAGM4ENT PLAN <br /> A Stormwamr Management Plan (SVgrW) sJoil be prq;nmd arorW agldicmion for coverage under a ae'.ncr3i <br /> permit, anti the following :e.-dAcaoon signed. See the SWMP requirements in Appendi:A. <br /> 'I c rdfy under penalty of law that a aomplete Stormwarer Managezzient Plan, in compliance with.Appendix A of <br /> he aI pli�don,]has been prepared f cor my dry. Based on my inquiry of the person or persons who manage <br /> the system, or those persons directly responsible for ,arhermg the information, he SWNIP is, to the best of my <br /> knowledge and belief. true; :iczuran, and comnl=. 1 am aware liar here are signiiitmmt penalties for falsely <br /> unifying the completion of;aid SW*ram, !ncluding-the possibility of?ate and imprisonment <br /> Z", //D 'y /�D _ <br /> Signature' f Perri[Applicant Date Signed <br /> Greg Nelson Mining Supervisor <br /> Name (printed) Brie <br /> 9. Signature of Applicant (legally responsible person) <br /> 'I certify under penalty of law that I have personally mined and am`=Riar with the information submitted in <br /> this application and all armcaments and that, based on my 9gairy of those individuals iumnediately responsible for <br /> obtaining the information. I believe that the information is troe, accurate anti wn4)lete. I am aware that there are <br /> significant penalties for submr=g false information, mcuding the pombilkty of fine and imprisonment.' <br /> ignature of f==Applicant Date Signed <br /> Greg Nelson Mining Supervisor <br /> Name (printed) — 'IStle <br /> :93/xg <br />