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. Standard Industrial Classifint~(blC) Code(s) for this facility. (Include tr~ four. io order of importanaJ <br />tt) 144? <br />b) 2951 c) 3273 d) <br />S. Reedvin` Stream: 7Le [tame of the receivioY stream(s). (If d'tstitage a ro a d'nch or :torn[ sewn, also include the <br />name of the ultimate receiving water.) r rr; oar; nn ditch to the Arkansas River <br />6. Describelheindustrialactivitieswhichtakeplayonsite. Excavation of agnreeate b~• floating <br />dredge, crushing/processing on-site, asphalt and concrete batch plants <br />7. Other Environmental PermiLt: Doer this facility currently have any environmental permits, or is it subject to <br />regulation, under either of the following programs? <br />No Yes Perr*.it .4 <br />a) Colorado Dischazge Permit System (CDPS or NPDES) <br />X <br />b) Colorado Mined Land Reclamation Boazd _ X M-93-659 <br />If ~, include MLRB permit anniversary date perm; r nnr yP~anted <br />8. STORMw'ATER MANAGEMEPlI' PLAN (`do not f+ll out ualas required, u discussed iri"the Incwttionc) <br />For those facilities spaified in the L-swaions only, a Stormwata Management Plan (SWMP) shall be prepared <br />prior to applying for coverage under a general permit, and the following certification signed. See the SWMP <br />requirements io Appendix A. <br />'I certify under penalty of law that a eomplae Stormwata Management Plan, in compliance with Append'u A of <br />the application, fiu been prepared for my facility. Based on my inquiry of the person or persons who manage <br />the system, or those persons directly responsible for gather'mg the information, the SWMP is, to the bat of my <br />knowledge and belief, true, accurate, and tbmplae. I am aware that these are significant penalties for falsely <br />eertifyiry~he completion of said SWMP, including the possibility of fine and imprisonment.' <br />-a -93 <br />0 <br />9. Signature of Applicant <br />res~~(ent <br />'I certify under penalty of law that 16ave personally aamined and am famil'ur with. the information wbmitted in <br />ffiis application and all anacbmeats and that, hued on my inquiry of those individuals immad'tatcly rapotuible for <br />obtaining the information, I believe that the information is true, arxvrue and eomplae. I ao awaze that these are <br />stgnrfi ~ tier for wbmrtting falu iaformatioo, iodudiny the poss3ility of fine and imprisonnteat.' <br /> <br />m <br />r~s; ~e <br />m <br />uoAZr~s 2- <br />