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d. Standard lndustrial Classification {SIC) Code(s) for this facility. {Include up to four, in order of importance.) <br />a) 1442 b) <br />c) <br />d) <br />Receiving Stream: The name of the receiving stream(s). (If discharge is to a ditch or storm sewer, also include the name of <br />the ultimate receiving wazers.) Receiving stream is a spring creek that leads to an irrigation pond and <br />ultimately to Cedar Creek south of US Highway 50. <br />6. Describe [he industrial activities which take place on site. <br />lndustcut! _tiuities nnsite ~neltul? sanrt anri gravrl Pxravatipo,~~chjng, erreaning,_, t~koiling <br />and asvhalt production. <br />7. Other Environmental Permits: Does this facility currently have any environmental permits, or is it subject to regulation. <br />under either of the following pro~ams? <br />n Yes Permit # <br />a) Colorado Discharge Permit System (CDPS or NPDES) X <br />b1 Colorado Mined Land Reclamation Board _ X_ M-2002-019 <br />If Yes, include MLRB permit anniversary date April 1, 2002 <br />8. STORMWATER MANAGEMENT'PLAN <br />A Stormwa[er Management Plan (SWMP) sAoU be prepared prior to application for coverage under a genera] permit, and the <br />following certification si}pted. See the SWMP requirements in Appendix A. <br />") certify under penalty of law that a complete Stonnwater Management Plan, in compliance with Appendix A of the <br />application, has been prepared for my facility. Based on my inquiry of the person or persons who manage the system, or <br />those persons directly responsible for gathering the infonna[ion, the SWMP is, to the best of my knowledge and belief, true, <br />accurate, and eamplete. I am aware that there are significant penalties for falsely certifying the completion of said SWMP, <br />including the possibility of fine and imprisonment" <br />Signature of Permit Applicam <br />h <br />9. Signature of Applicant (legally responsible person) <br />_ o z <br />Date Sigtted <br />Title <br />"I certify ta~der penalty of law that 1 have personally examined and am familiar with the information submitted in this application <br />and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, l <br />believe that the information is true, accurate and complete. 1 am aware that there are significant penalties for submitting false <br />mformation_ including the possibility of fine and imprisonment." <br />~, 2 - 8 Z <br />Signature of Permit Applicant <br />Name (printed] <br />-rv3r,~ <br />-2- <br />Date Signed <br />Title <br />