Laserfiche WebLink
. <br />f• <br />• III III~IIIIIIII~ III ~~3 ~ 5~~3 o/~icn. <br />FOR AGENCY USE ONLY <br />PROCESS WATER AND STORMWATER <br />DISCHARGES ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALLIC n4rrvFRAr c <br />EXCEPT FUEL) <br />II PERMIT NUMBER <br />C101 I- <br />DATE AECEiVED <br />YEAR I MONTH I DAY <br />II II TYPE: P S <br />Please print~o7r(type. Do not attempt to complete this form beforc reading the instructions. Rg~QIVBd <br />New Q or Renewal ^ If renewal, existing permit outnber: CO <br />,i ; ~ _; ;:,0 t1AR 1 2 2~C1 <br />I . Name and address of permit applicant: tJ U~C r 1 v L <br />Company Name: Four States Aggregates, LLC V <br />Federal Taxpayer (or Employer) ID//: <br />Division of Minerals 8 Gsology <br />Mailing Address : PO Box 1368 <br />City, State and Zip Code : CORTEZ, CO 81321-1368 <br />Phone Number : ( 970 ) 363-3388 <br />Local Contact (familiar with facility): Aryol Brumley Title: Manager <br />Phone Number: ( 970 ) 363-3388 Fax No.: ( 970 ) 363-1037 <br />Who is applying for the permit? ^ Owner Q Operamr <br />2. Name and address of property owner: <br />Mailing Address : 22374 Highway 143/ PO Box 438 <br />City, State and Zip Code : Dolores, CO 81323 <br />Phone Number : ( 970 ) 882-7383 Fax No.: ( ) <br />3. Location o[ the Padllty: <br />Street Address: 21944 Highway 143 <br />City, State and Zip Code: DOLORFS. CO 81323 <br />County: MONTEZTJMA Name of facility: LINE CAMP PIT <br />Legal Location (Township, Range, section, I/4 section): SE 'ti of NW t4 of Sec 22, T38N, R14W, lOm (NM) PM, Montezuma County <br />Latitude and Longitude: 37d 31 m 47s. IOSd 22m SOs <br />4. Standard Industrial ClttssiSndon (S[C) Cade(s) for [his facility. (Include up m four, in order of importance. See Appendu AJ <br />a) 1442 b) <br />c) <br />d) <br />3. Receiving Stteam: The name of the receiving stream(s). (]f discharge is to a ditch or smrm sewer, also 'occlude the name of the ultimate <br />receiving waters.) Afield drain line discfuryjng into the Dolores River <br />