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~~b ~Q~ . . <br />d. Standard Ltdostriat CLsedlira6ua (SIGH Code(e) Cor this facTity. (t~Iuda up m four, in order of haportanceJ <br /> <br />c) <br />5. Saotavtag Stream: Tho name of the receiving stream(s). (If dis~ur¢{C is to a <br />name of the ultimate receiving waters.) ~~ r ~ ~f ~~ ~- \ ~+'e ~° <br />a~ <br />or storm sewer, also include the <br />6. Ilestrlbe tbe industrial adivilies which take place en Bite. ~~+--r Tye /P . ~- ~ . <br />v ., <br />7. OUter Firrh~anma-tal Ptrwiis: Ilucx thin fudity wrrenUy Lave nay orrvirawnenta] pnruvta, or is it sub]tCi to <br />regttlatlon, under either of the following pragramg7 <br />No Yes Permit 4 <br />a) Colorado Discharge Permit System (COPS or IdFD3S) ~ _ - - <br />b) Colorado IN'ared Land Reclamation Board ~. ,~ /i'1- 7-7-3~s <br />Lf yam, indatie htI.RB permit aauiversary data _~~~3_ <br />8. STpIiMWA'I~R MANAGffi4IFS7f PLAN <br />A 5tomtwatex Management Pion (SWi~ s1roA be pnpand prior m appfiaadon for caverago under a geperal <br />permit, and the following certification signed. Son dto SWNIP mgttiraaenta is Appaodix A. <br />'I catifj under penalty of law root a aunpl&a SLormwat~ Manggamoot Pfau, in cotnptimce with Appeadis A of <br />the appliretlon, has beet peapared for my faulity. Based on my inyuiry of the person or pnrsony rvho irtanaQa <br />the system, or Ihosa paLSOne directly responsible for garoertnY tLa information, the S WaSP is, to the best of my <br />Imowltdga and belief, true, ^rri,rarr~ and r»~lere. I am aware roar there are significam penalties for falsely <br />certifying the completion of said SWitrP, including the possibt~dy of flue and imprisonmenu.' <br />9. i~gtature of Apglicactt (lesally respoaaibk person) <br />"I ratify Hadar penalty of law that I Lava peraonaily examined and em familiar with the information submitted in <br />this application and all attachLnaaats sad that, based on my intptuy Of those i.rVivi gala immediately rcspom~ie Wr <br />obtaining the information, I believe tLat the information is vue, accutata acrd oomptete. I am aware that there are <br />significant pmaltiea for submitting false iafortnation, including the possibility of fine sad imprisonment.' <br />7/97ha <br />' \ S0'd S©Li69c6LLi <br />-2- <br />Ol SN9Ilf11G5 -N1N3lJNOilifdJ3 WO'tld WdTZ:t9 b66T-TZ-bO <br />Signahue of(~6nnit Appiit.ant Date Signed <br />Signahtre t>~Ytxmit Appli~nf. I7aUe Signed <br />