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LORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT May I5, 2002 Water Quality Control Division WQCD-P-B2 - 4300 Cheny Creek Drive South Denver, CO 80246-1530 SAND & GRAVEL MINING AND PROCESSING (AND OTHER NONMETALLIC MINERALS EXCEPT FUEL) STORMWATER DISCHARGE CERTIFICATION REAPPLICATION & RECORD VERIFICATION FORM This force is for reapplication for the Grand Gravel faculty (COG-501149) under the Sand and Gravel Stormwatbf Discharge Permi[. By filling out and signing this form and returning it to the address at the top, you will have reapplied. In order to reapply by this simplified method, and to avoid a gap in coverage for your facility, you must return this form by June 30, 2002. Do not send an money with this form -the billing process is handled separately. More information about this process is contained in the cover letter and Q&A that accompany this form. This rs the latest information that we have in our reeordsjor your jaclUty. Please review the lnjormation carefully and make whatever changes are necessary, by crossing out the incorrect lnjormation and writing In the new, and sign the form below. ''RETAIN A COPY OF THIS FORM FOR YOUR RECORDS'' Perminee Injormatlon, including name ojlegully responsible person who is signing this form: Permittee - Grand Gravel Federal Taxpayer ID Number - 840470754 Legally Responsible Person - Richard E. Curry, Co-Owner Phone - 970/872-3545 Mailing Address - P.O.Box 566 Hotchkiss, CO 81419- Name, /ocadon and description ojlndusMal acdvlry for permtued facility: Facility Name - Grand Gravel Facility Address - Cnty Rd 2, 1 Mlle N, of US 40 Kremmling, CO 80459- Facility County - Grand Legal Location (Township, Range, Section) - T-O1N,R-OSOW,S-12 NE Latitude - 40/04/45 Longitude - 106/18/00 Description of Industrial Activities -Sand gravel minSng, sand and gravel crushing, mobile asphalt plant, mobile concrete batch plant. Local contact familiar with the site: Local Contact - Richard E. Curry, Co-Owner Local Contact Phone - 970/872-3545 Standard lndustrla! CiassiJlcatton (SICJ coda are used to describe the industrial acdvltles at a slt¢ Up !o jour are included in our database !n order ojlmportonee. For a description ojthe aettvlties corresponding to the codes below, go to hrro://www.osha.cov/c¢i-bin/sic/sicser5 (theJlrst 1 digits ht the codes below are Jhe_ maJorgroup): szC Code(s) - 1400 Storm water Diseherges to: Receivino Streams River To complete this Reapplication, the Legally Responsible Person Warned above must sign the following certification: I terrify under penalty ojlaw that 1 have personally examined and am jaml/tar with the lnjormation submitted on this form and rhar I believe rhar the lnjormation is true, accurate and complete. Further, 1 understand that by completing and returning this form, /have applied for coverage under the revised genera! permit for for Sand and Gravel Mtning and Processing (and other Nonmerallic Minerals Exeepr Fue!), COG•500000J.