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1 <br />GENERAL PERMIT APPLICATION <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALLIC MINERAIS <br />EXCEPT FUEL) <br />(Permit No. COG-500000) <br />Please print or type. Do not attempt to complete this form before reading the instructions. <br />1. Is this the correct application for your faality?? This application is only for the dischazge of stormwater. <br />Do you discharge aay of the following process generated wastewaters from your facility? <br />0 No ^ Yes <br />L'".l' No ^ Yes <br />ONo ^Yes <br />No ^ Yes <br />No ^ Yes <br />Product wash waters <br />Mamtenant:e/equipment wash waters <br />Transport waters (e.g., slurries) <br />Scrubber waters (crushers or classifiers) <br />Mine dewatering (groundwater and/or runoff from the mine) <br />If you answered ~ to any of these questions, do not complete this application. You must instead complete the <br />Process Water and Stocmwater Discharges Assotiated with Sand and Gravel application for this facility, which is <br />available from the Division. <br />2. Name and address of permit applicant: <br />Company Name: Castilla Countv Road & Bridge <br />Federal Taxpayer (or Employer) IDI/: 8 4 6 0 0 0 7 5 4 <br />Mailing Address: P . o . Box 10 0 <br />City, State and Zip Code: San Luis C 0 81 15 2 <br />Phone Number: ( 719 1 6 9 2 - 3 3 7 2 who is applying for the permit? ~ Owner ^ Operator <br />LOCaI Contact (famillaz Wlth faClllty): ~t a t h e w V a l d e z <br />Title: R/B Compliance Rep. phone Number: ( 719 ) 672-9109 <br />3. Location of the faality: <br />Street Address: 13 0 8 5 Hwy . 14 2 <br />City, State and Zip Code: San Acacio C 0 81 15 0 <br />Coon Name offacili ; San Acacio Gravel Pit <br />tY Cestilia ty <br />Legal Location (Township, Range, section, 1 /4 section): S 2 8, T 3 N, R 7 3 W, S W 1/ 4 <br />Latitude and Longitude: 1 o s. 5 7 - 3 7.19 <br />Type of Facility: ^ New (beginning operations after 10/1/92) 0 Existing (as of 10/1/92) <br />FOR AGENCY USE ONLY <br />Certification Number <br />C O G- 5 0 <br />Date Received Fce Category <br /> <br />Yeaz Month . Day <br />7/93/sg _1_ <br />