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GENERA:. PERMIT APPLICATION <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH <br />AND AND GRAVEL PRODUCTION <br />v1'ERATIONS (AND OTHER <br />NONMETALLIC MINERALS <br />For Aaencv Use Only <br />cox-so L:2 ~ 9 <br />Date Received <br />Year Month Day <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 />I . Is this tfie correct application for your facility?? This application is only for the discharge of stormwater. <br />Do you discharge any of the following process generated wastewaters from your facility? <br />No ~ Yes Product wash waters <br />No ~ Yes Maintenance/equipment wash waters <br />O ~ <br />No Yes Transport waters (e.g., slurries) <br /> ~ i <br />No Yes Scrubber waters (crushers or class <br />fiers) <br />Q Nu ~ Yes Mine dewatering (groundwater and/or runoff from the mine) <br />!f you answered Yes to any of these questions, do not complete this application. You must instead complete the Process <br />Water and stormwater Discharges Associated with Saad and Gravel application for this Facility, which is available from <br />the Division. <br />2. Name and address of perrnii applicant: <br />Company Name: <br />Federal Taxpayer (or Employer) 1D#: ~ 2 4 2. g 4 ~ ~ 1 <br />Mailing Address: 384 63.30 P~r~9d <br />City, State and Zip Code: Montrose rolorado 81A01 <br />Phone Ntunber: ( 970) 249-9436 Who is applying for the permit? ~ Owner ~ Operator <br />Local Contact (familiar with Facility): <br />Title: Nick H. Gran/Owner Phone Number: ( 970 ) 249-9436 <br />3, Location of the facility: <br />Street Address: Neaz Mile Post 101, US hiQhway 50 <br />City, State and Zip Code: Montrose, Colorado 81401 <br />Cormty. Montrose Name of facility: ray rt <br />Legal Location (Township, Range, section, 1/4 section): SW1I4 NWl/4 Sec. 24, T49N, R8 W, N.M.P.M. <br />Latitude artd Longitude: N38°29.825' ; W 107° 43.563' <br />Type of Faciliry,~ New (beginning operations afrer 10/1/92) ~ Existing (as of 10/1/92) <br />i~3~,~ <br />