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<br />a <br />NATIONAL POLLUTANT OISCHARGE ELIMINATION SY ST EH <br />APPLICATION fOR PERMIT TO DISCHARGE - SHORT FORM <br />HUN IC IPAL, INDUSTRIAL <br />R AGENCY USE <br />PLICATION NUMBER <br />DATE RECEIVED <br />YEAR M0. DAY <br />Do not attempt to complete this form before reading [he accompanying Instructions <br />Please print of type <br />1. Name, address, and telephone number of [he owner of [he facility producing <br />discharge. _ <br />A. Owner <br />B. Facility name Loveland D1tS <br />C. Mailing Address 644 N. Countv Road 19E, P.O. Box 299 <br />D. city Loveland D. state Colorado <br />E. County I arimar F. Zip Code Rf1S77 <br />G. Telephone Number ( ~[)~ ) F~j]-11(16 <br />Area Code ~ ' <br />z. Location of facility portions of the NE1/4 of Sec. 17, N1/2 of Sec. 16, <br />A. Legal brief description SE1/4 of Sec 16 Wl/2 of Sec 15 all T5N, R69W <br />B. Street 644 N Countv Road 19E P 0 Box 299 <br />c. city Loveland D. co~ncy Lorimer <br />E. state Colorado Rf1547 <br />F. Telephone Number ( 303 ) 667-1108 <br />Area Code <br />C. Local toncact George A. Panther <br />7. Sanitary discharges (only for sewage treatment facilities). <br />A. Unit trea tmen[ processes utilized NA <br />B. Design flow (average daily) of facility ~ ~NA HCD . <br /> <br />L. Percent BOD removal (actual-previous year) NA s <br />D. Population served ~ NA <br />E. Number of discharge points NA <br />F. Description of discharge location(s): NA <br /> <br />G. Name of receiving water(s): NA <br /> <br />H. Is land application used or planned? NA <br />I. Me [hod of sludge disposal NA <br /> <br />J. (1) Do you receive industrial waste? NA <br /> <br /> (2) If yes, describe the sources NA <br />K. Attach any laboratory analyses of your effluent quality <br />