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<br />r1 <br />~~ <br />4. Industrial discha rges (industries, mines, gravel pits, water treatment plan [s, <br />e [c.) <br />A. Description of facilities Gravel Plt <br />9. Principal product or raw material Sand and gravel <br />C. Max (mum amount of principal product produced or raw material consumed <br />per daY ~5n f•nnc <br />D. Check [he month(s) the discharge occurs <br />J 0 F ~ M ®A ® H ~ J ®J ©A ®S ®0 ®N ®D Q <br />E. Unit treatment processes u[ilized_ _settl lnQ pond <br />F. Number of discharge Doints One <br />Near the point where the Big Thompson River <br />G. Description of discharge location(s):_______ ~c_ ___~___ ~_.._~ <br />ary line.(See photo- <br />H. Name of receiving water(s) Big Thompson River map) <br />I. 1.5 land application used or planned? NO <br />J. Attach any laboratory analyses of your effluent quality N/A <br />5. Addi [ional information (sketches, etc.) <br />1 certify [hat 1 am familiar with the info rma[ion contained in [he application and <br />[ha[ to the best of my knowledge and belief such information is [rue, comple [e, <br />and accurate. Please review siynatu re aF application on instruction sheet before <br />signing. e <br />E.A. Rossum <br />Printed Name of Person Signing <br />Owner <br />Title <br />20 April 1979 <br />Daie Application Signed <br />L•L~L- <br />Signature of Applicant <br />