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~ - <br />L FOR 4GENGY USE <br />APPLICATION NUMBER <br />' NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM DATE P.ECEIVED <br />APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORn <br />MUNICIPAL, INDUSTRIAL YEAR MC. DAY <br />Do not attempt co comple [e this form before reading the accompanying instructions <br />Please print or type <br />1. Name, address, and telephone number of the owner of the facility producing <br />discharge. <br />A. Owner Tucker Construction Company <br />D. Facility name Tucker Aggregate <br />c. nailing Address 4563 East County Road 68 <br />D. city Wellington D. state Colorado <br />E. county Latimer F. Zip Code 80549 <br />~ G. Telephone Number (303 ) 568-3597 <br />Area Code <br />2. Location of facility <br />A. Legal brief description $ecti0ns 17.20 T11N. R67W <br />B. Street NA <br />c. city NA D. co~ncr Weld <br />+ E. State Colorado <br />f. Telephone Number ( 303 ) 568-3597 <br />• Area Code <br />G. Local cpncacc Mr. Lee Tucker <br />3• Sanitary discharges (only for sewage treatment facilities). <br />A. Unit treatment Drocesses utilized NA <br />8. Design flow (average daily) of facility NA NGD . <br />C. Percent DOD removal (ac[ua I-previous year) NA $ <br />D. Population served NA <br />E. Number of discharge points NA <br />F. De scrlp[ion of discharge loca[ton(s): NA <br />G. Name of receiving wa[er(5): NA <br />H. Is land application used or planned? NA <br />I. He [hod of sludge disposal NA <br />J. (1) Do you receive industrial waste? NA <br />(2) If yes, describe the sources NA <br />K. Attach any laboratory analyses of your effluent quality NA <br />