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..' <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM <br />APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM <br />MUNICIPAL, INDUBTRIAL <br />Do no[ atcempt to complete this form before reading [he accompanying instructions <br />Please print or type <br />I. Name, address, and telephone number of [he owner of [he facility producing <br />discharge. <br />A. Owner <br />B. Facility name Rossum Pit <br />C. Mailing 'address 4524 West Eisenhower Blvd. <br />D. city Loveland D. scare Colorado <br />E. county Larimer F. Zip Code 80537 <br />G. Telephone Number ( 303 ) 667-4088 <br />Area Code <br />2. Location of facility <br />A. Legal brief description part of the NF1/~ Sec. 17 TSN. R69W, 6th P.M. <br />B. Scree[ Access from State Highway 34 <br />c. city Loveland D. county Larimer <br />E. State Colorado <br />F. Telephone Number ( 303 ) 667-4088 <br />Area Code <br />G. Local contact E.A. Rossum <br />7. Sanitary discharges (only for sewage traatment facilities). <br />A. Unit treatment processes utilized ~J/A <br />B. Design flow (average daily) of facility ~~/A MGD . <br />C. ~ Percent BOD removal (actual-previous year) N/A °e <br />D. Population served N/A <br />E. Number of discharge points N/A <br />F. Description of discharge location(:>: N /A <br />G. Name of receiving eater(s): N /A <br />H. Is land application used or planned? N /A <br />I. Method of sludge disposal N /A <br />J. (I) Do you receive industrial waste? N /A <br /> (2) If yes, describe [he sources N/A <br />K. Attach any laboratory analyses of your effluent Gualicy N/Q <br />