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<br />PROCESS WATER, STORMWATER AND GROUND <br />WATER <br />DISCHARGES FROM INDUSTRIAL WASTEWATER <br />FACILITIES <br />c <br />Pkax print or type. Ian not attempt b complete this form before trading the instructions. <br />New ®or Rrnewal ^ ifrenewel, existing permit number. CO-00 <br />Name and addrssa of permit applicant <br />Company Neme: ~Oi~.f l ~ 2c5 o..r 2CL5 t,l M t'[ti D <br />Fedcnl Taxpayer (or Employer) IDtl:~+ 4 I 2 ~+ 1 ~ ~ <br />Mailing Address : Q - d ~G>fi 4'(3 <br />City,S4teandZipCode: ,~At~tit~. CO i314Z~', <br />Phone Number :(-' I<1I 5Z7- y-l3S Who is applying for the pertnil7 ©Owncr ^ Operator <br />heal Confect (familiar with Ceeility): a As 1 L $EA t2-- <br />Title: ~HV t2o..t n1~3µT0. ~ Phone Number: 01101 c, L"1 - 2 L7 b Psx No.: <br />Co a(LL~ r a p.•~ 2 <br />n--lu-5L1-Z23~- <br />Name and address of property owner. <br />Name: ~PPI.r C AN T"- <br />Mailing Address <br />City, Stele and Zip Codc <br />Phone Number:( ) Fax No.: <br />3. Locatbo of the 6c(llty: <br />titrwfAddrcw: ~L~ S'CATG 1~1Gt4}lJ[j`! (33 5 r"~tL~S NG OF t~'AONtA Cp _ <br />City, State and Zip Code: (7~OW t C ~ C O B 14 Z 8 <br />County. l~Et-'TA NemeoCfacility: ~Wt+= ~J L M+ar <br />Legal Loeation (township, Range, section, I/4 section): T 1 ~ ~ s R 4 1 ~ j S~c C ~ I ~ hl ~_- ~4' <br />latitude and Longitude: ~ ~'o rJ' ~ , ~ ~' 'r l U~ 0 31 . Z ~' •• <br />4. Standard IndusMd Classification (SIC) Code(s) for this ficility, (Include up b (our, in order of importance.) <br />a) ~ ~ b) c) <br />• <br />