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r <br />• • <br /> <br />4. InduS[rial discha rgas (industries, mines, gravel pits, water treatment plants <br />eL~-. ) <br />A. Description of facilities GRAVEL PIT <br />B. Principal product or raw material SAND & GRAVEL <br />C. Maximum amount of principal product produced or raw material consumed <br />per day_1OO0 T~DAY___ _ __ __ ____ <br />D. Check Che month(s) the discharge occurs. <br />J® F® M® A® N~ J ® J® A® S® 0® N® D <br />E. Unit treatment processes utilized (Ij RFfT nTCf F1A Rf.F T(I RTVFR <br />F, Number of discharge poinCS ONE <br />G. Description of discharge location(s): AT POINT OF MINING <br />N. Name of receiving wacer!s) CACHE LA POUDRE RIVER <br />1. Is land application used or planned? NO <br />J. Attach any laboratory analyses of your effluent quality N!A <br />S• Ad<li [ional info rmatlon (sketches, etc.) <br />Application has been made to Colorado Mined Land Reclamatioh <br />Board and Weld County for Open Pit Gravel Mining Operation. <br />Pit lies adjacent to river. <br />I certify that I am familiar with [he information contained In the application and <br />chat [o the best of my knowledge and belief such information is [rue, complete, <br />and accurate. Please review signature of application on Instruction sheet before <br />signing. <br />~/Cf1 ff~PD ~.r~C ~5~1 <br />Printed Name of Person Signing <br />~ W /IlIE,P <br />title <br />Signature of Applicant <br />