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Y. Describe the industrial activities which take place on site. <br />7. Other Environmental Permits: Does this facility currently have any environmental permits, or is it subject to <br />regulation, under any of the following programs? <br />No Yes Permit# or ID# <br />a) Colorado Dischazge Permit System (CDPS or NPDES) <br />b) Resource Conservation and Recovery Act (RCRA) _ _ <br />- If Yes, is your facility a Treatment, Storage or Disposal facility? _ _ <br />c) Colorado Division of Minerals and Geology (formerly MLRD) _ _ <br />d) Superfund Amendments and Reauthorization Act (SARA), Title III <br />(Emergency Planning and Community Right-to-Know Act), Section 313 _ <br />NOTE: Both Items 8 and 9 must be signed in order for the application to be processed. <br />8. Stormwater Management Plan <br />a) Heavy Industry, Light Industry, Mining: a Stormwater Management Plan (SWMP) shall be prepazed prior to <br />applying for coverage under a general permit, and the following certification signed. See SWMP requirements in <br />Appendix B (Light and Heavy Industry) or Appendix C (Mining). <br />"I certify under penalty of law that a complete Stormwater Management Plan (SWMP), in compliance with <br />Appendix B / C (circle one) of the application, has been prepazed for my facility. The SWMP was prepazed <br />under my direction or supervision and with a system designed to assure that qualified personnel properly gather <br />and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, <br />or those persons directly responsible for gathering the information, the SWMP is, to the best of my knowledge <br />and be]ief, true, accurate, and complete. I am awaze that there are significant petalties for submitting false <br />information, including the possibility of fine and imprisonment." <br />Signarure of Permit Applicant Date Signed <br />Name (printed) Title <br />b) Heavy Industry: the permittee shall also submit a copy of the SWMP to the Division with the permit application. <br />SWMP enclosed? ^ No ^ Yes <br />9. Signature of Applicant (legally responsible person) <br />"I certify under penalty of law that I have personally examined and am familiaz with the information submitted in <br />this application and all attachments and that, based on my inquiry of those individuals immediately responsible for <br />obtaining the information, I believe that the information is true, accurate and complete. I am awaze that there aze <br />significant penalties for submitting false information, including the possibility of fine and imprisonment." <br />Signature of Permit Applicant <br />Date Signed <br />Name (printed) <br />Title <br />7/96/ltun -2- <br />