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<br />L <br />GENERAL PERMIT APPLICATION <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH: <br />LIGHT INDUSTRIAL ACTIVITY <br />(Permit No. COR-010000) <br />HEAVY INDUSTRIAL ACTIVITY <br />(Permit No. COR-020000) <br />METAL MINING (Permit No. COR-040000) <br />Please print or type. Do not attempt to complete this form before reading the instructions. <br />1. Name and address of permit applicant: <br />Company Name: Cnl nradn Di vi ci on of Minerals and (=eoloev <br />Federal Taxpayer (or Employer) ID€1: 8 4- 0 6 4 4 7 3 9 <br />Mailing AddieSS: 1 3l't Sharman Ctreet Room 215 <br />City, Stale and Zip Code: Denver Colorado 80203 <br />Phone Number: ('303 ) 866-3567 Who is applying for the permit? LJ Owner LJ Operator <br />Local Contact (familiar' with facility): ~tavan Rannar <br />Title: project Manager Ptlone Ntunber: ( 970 ) 241-0336 <br />2. Location of the facility: <br />S[ree[ Address: End of Coal Creek Road, 4 miles west of Redstone <br />City, State and Zip Code: Redstone Colorado 81623 <br />Cotmty: Pitkin Name of facility: Coal Basin Reclamation Construction Proiects <br />Legal Location (Township, Range, section, 114 section): T10s. R89w. Sec 11. Swl/4 <br />Latitude and Longitude: t 0~ 1 R' 02" . 39 t t' S5" _ <br />Type of Facility: ^ New (beginning operations after 10/1/92) ^ Existing (as of 10/1/92) <br />3. Standard Int~ttstrial Classification (SIC) Code(s) for this facility. (Include up to four, in order of importance.) <br />Rec amation <br />a) n/a Construction b) c) d) <br />4. Permit Category: Under which stormwater general permit does this facility belong? (See Appendix A.) <br />^ Heavy Industry ^ Light Industry ^ Metal Mining (or Coal -see Instructions) <br />Mines only: MLRB permit anniversary date nnna ~ nermi t Which category is your facility under? <br />revoked <br />^ Active mine, less than 10 acres ^ Active mine, 10 acres or more ^ Inactive mine <br />5. Receiving Stream: The [tame of the receiving stream(s). (If dischazge is to a ditch or storm sewer, also include the <br />name of [he ultimate receiving waters). Dutch Creek Coal Creek <br /> <br />FOR AGENCY USE ONLY <br />Certification Number <br />C O R - 0 <br />Date Received Fee Category <br /> <br />Yeaz Month Day <br />7/964hm ,.,.. -.~1- <br />