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<br />Page 2 (PERMIT INACTIVATION FORM) <br />3.. Will the permittee continue to have a discharge point, <br />such as pipe, conduit, unlined lagoon, etc? YES NO <br />4. Under what conditions could a discharge occur: Storm flow, y/~ <br />change in operation, accidental spill, etc. <br />5. IF this 1s a mining fac311ty or operation, indicate whether /~~~ "•Ae <br />any mine drainage exists. Discuss whether there has been a ~ /+•:~~v~-w«-~~"tea <br />his COri Cal flow. ~~~wvt >!°•~ /'~saH ~~ ~Ys~.ts~v-. o~~..i/Y-.an-»~ t~~~ac~ iC•:.~v(r <br />ca..~~ont. ~...r' i~~crs ~J err`~~se~! <br />6. Is there a dovnsereem water user, water sup/ply intake, etc.? ~ N'O/ <br />a. If yes, whom and /where? .etc <rlit.~gr/s~~a.. ~•!v /~-%'~J-o-+ o~G~1 %~mo--yrs.' <br />`~~ies~~-:. ~cJ /v~~rs~J.o.. i:r ~~~~c.- /~'~-~.irilr.~ J ~j..v,r.:°ra-~~ O.C..w-./ <br />y°rns~cw.°- wwq~ irss i-o~.fn'n v~(~;C'cd ~ ti-+r s~"cair. ~,~i-ri ~~~iir-'7~a7 <br />b. Could they be impacted by a discharge or a spill ~6f ~rr~+..-~~;,~-~~,.« .s <br />nay pollutant on-site controllable under an SPCC ~an / %/'°*""~ ~.-~ iP7 <br />or other co}dition of a permit? ,/I7:sr."r r/osr/a~ur YES <br />G..,~.~i/~c O'r~~j >°~rsct...~~ s.~ tc~v-:~~s cic~ rya evws ~~5''ia~:. pi. yr ,.• <br />NOTE: TFD; FOLLOWINQiSHOULD BE KEPT IN POND IF YOUR PERMIT IS INAC~VAT~ urr /~~/r !~~ <br />~..y/ouire~ <br />1. The permittee will still be responsible and subject to any enforcement <br />action for any discharge or spills into state waters. Should you operate <br />your facility after your permit has been inactivated and a discharge could <br />occur, you must apply for a new permit ao less than 180 days prior to the <br />discharge. It is unlawful to discharge pollutants from a point source to <br />state waters without a permit. Section 25-8-608 of the hater Quality <br />Control Act provides for assessing civil penalties of up to 110,000 per <br />day for unlawful discharges. <br />2. In general the continued existence of a discharge point will be the basis <br />for not inactivating a permit at the request of the permittee. <br />I certify that the above information is accurate, true and complete to the <br />beat of my knowledge. <br />~~3 <br />Aut oriz d R eseat ve Date <br />Based upon my verification of the above information obtained during my site <br />inspection, it Ss my recommendation that this permit be inactivated. <br />YES NO <br />District Engineer Date <br />