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ENERAL PERMIT APPLICATION <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALLIC MINERALS <br />EXCEPT FUEL) <br />(Permit No. COG-500000) <br />For Aeencv Use Oniv <br />CUR-50 , <br />Date Received <br />Year Month llay <br />Please print or type. Do not attempt to complete this form before reading the instmctions. <br />] Is this the correct application for your facility?? This application is only for the discharge of slormwater. <br />Do you discharge any of the following process generated wastewaters from your facility? <br />/ n ~ <br />No Yes Product wash waters <br />O No n Yes Maintenance/equipment wash waters <br />N ~ Y T <br />l <br />i <br />o es rnsport waters (e.g., s <br />urr <br />es) <br />No o Yes Scrubber waters (crushers or classifiers) <br />No ~ Yes Mine dewatering (groundwater andlor runoff from the mine) <br />If you answered Yes [o any of these questions, do not complete this application. You must instead complete the Process <br />Water and Slormwater Discharges Associated with Sand and Gravel application for this facility, which is available from <br />the Division. <br />2. Name and address of permit apphe~ut <br />Company Name: ~f IC IC ~_(~K,4 ~/ <br />Federal Taxpayer (or Employer) IDk: ~ .2 ~ ~ S <br />Mailing Address: ~, 3~ O <br />City, State and lip Code: I~OArf.~Se f ~4~ <br />Phone Number (~7d) ,Z ~/ ~ 9 /~ 3 (~ Who is applying for the permit? ~ Owner ~ Operator <br />Local Con[a (faLmiliar with facility ~ G Ate, <br />Title: /~(IGA ~. ~QdAJ~k~~ Phone Number: ( [ ~ ) ~-f 1 ~ ~4~6 <br />+. Location of the facility <br />Street Address: / ~ <br />City, State Ztp Code: <br />County: -~~~ Name of facility: / ~ <br />Legal Location (Township, Range, section,) 1/4 sectionL): / <br />Latitude and Longitude: /~ ~ r~ I ~ l t ~ 12~~ O ~ ~'~ <br />Type of Facitit~ew (beginning operations after IQII/92) ~ Existing (as of ]0/1/92) <br />?!s3is~ - I - <br />