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FOR AGENCY USE ONLY <br /> PROCESS WATER AND STORMWATER PERMIT NUMBER <br /> DISCHARGES ASSOCIATED WITH C 0 <br /> SAND AND GRAVEL PRODUCTION DATE'RECEIVED <br /> OPERATIONS (AND OTHER <br /> NONMETALLIC MINERALS YEAR MONTH DAY <br /> EXCEPT FUEL) TYPE: P S <br /> Please print or type. Do not attempt to complete this form before reading the instructions. <br /> I. Name and address of permit applicant: <br /> Company Name: CONNELL RESOURCES, INC. <br /> Federal Taxpayer(or Employer)ID#: 84-0588541 <br /> Mailing Address: 4305 EAST HARMONY ROAD <br /> City,State and Zip Code: FORT COLLINS,CO 80528 <br /> Phone Number: (970)223-3151 <br /> Local Contact(familiar with facility): RICHARD CONNELL <br /> Title: PRESIDENT Phone Number:-(970) 223-3151 <br /> Fax No.: (970)223-3191 <br /> Who is applying for the permit? Owner Vf Operator <br /> 2. Name and address of property owner: <br /> Name: ESTHER WEITZEL <br /> Mailing Address: P.O. BOX 116 <br /> City,State and Zip Code: TI MNATH,C0 80547 <br /> Phone Number:" <br /> 3. Location of the facility: <br /> Street Address: Located at the intersection of Larimer County Road 36 and Frontage Road east of 1-25 south of Harmony Road <br /> City,State and Zip Code: <br /> County: LARIMER Name of facility: TIMNATH CONNELL PIT <br /> Legal Location(Township,Range,section, 1/4 section): SE'A of Sec.3,T 6 N,R 68 W <br /> Latitude and Longitude: Latitude 400 30',Longitude 1040 59' <br /> 4. Standard Industrial Classification(SIC)Code(s)for this facility. (Include up to four,in order of importance. See Appendix A.) <br /> a) 1442 b) 2951 c) d) <br /> 5. Receiving Stream: The name of the receiving stream(s). (If discharge is to a ditch or storm sewer,also include the name of the ultimate <br /> receiving waters.) CACHE LA POUDRE RIVER <br /> SAND AND GRAVEL 5/93 I <br />