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~jft~ERAL PERMIT APPLiCA'I~I 11111I,411IlIlll III <br />S7'ORMWATER DISCHARGES sss <br />ASSOCIATED WITH <br />SAND AND GRAVEL. PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALLIC NIINFRAIS <br />EXCEPT FUEL) <br />(Permit No. COG-500000) <br /> <br />Pl~~se print or type. Do rat attempt to complae this totm before reading the instruaions. <br />1. Is this the correct applicttion for your taality?? This application is only for the discharge of slorm~r~aler. <br />Do you discharge any of the following process generated wastewater from your facility? <br />0 No ^ Ya Produa wash waters <br />No ^ Ya Maintenance/equipment wash waters <br />No ^ Ya Transport waters (e.g., slurria) <br />No ^ Ya Sctvbber waters (crushers or classifiers) <br />No ^ Ya Mine dewatering (groundwater and/or runoff from the mice) <br />If you answered y~ to any of thae questions, do not complae this appliation. You must irutead complae the <br />Process Water and Stormwater Discharges Associated with Sand and Grarel application for this facility, which e <br />available from the Division. <br />2. Name and address of the permit applicant: Taxpayer (or Employer) IDD Applied For (not <br />Name Mid-Western Farms c/o George Tempel received) <br />Mailing Address P. 0. Box 246 <br />City, State and Zip Code Wiley, CO 81092 - - <br />Phone Number ¢141 R 2 4 - a ~ 5 n Who u applying for the permit? ®Owner ^ Operator <br />Local Contact (familiaz with facility) Gark Tuttle _ <br />Tide Consultant Phone Number (3031 452-6611 <br />3. Location of the fsdGty: _ <br />Strea Address U.S. Highway 50 - 1-3/4 miles south and west of Holly, Colorado <br />City, State and Zip Code Holl.v. Colorado 81047 <br />County Prowers Name oftacility Mirl-lVastern Farms Resource <br />Township, Range,aeaion,l/4tteaion Township 23 South, Range 42 West, Sections 17 and 1 <br />ctio <br />LatiNdeandLongitude 380 2'45" North. 102° 11'15" West ~ ~ ~ 1'~, 14 <br />Type of Facility: ^ New (beginning operations after IWll92) ^ Eitst;ttg (as o[ 10/1/92) <br />R AGENCY USE ONLY <br />Certifieatim Number <br />c o G- s o <br />Date Raeeivad Fee Category <br /> <br />Year ltlaotb nay <br />torrzr.t -1- <br />