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GENERAL43359
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Entry Properties
Last modified
8/24/2016 8:12:09 PM
Creation date
11/23/2007 12:20:24 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
C1981017
IBM Index Class Name
General Documents
Doc Date
7/6/2006
Doc Name
Metal Mining Stormwater Discharge Permit-Reapplication Second Notice
From
Stormwater Permit Ponds Folder
Permit Index Doc Type
Reclamation Project
Media Type
D
Archive
No
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CQLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT July 6, 2006 <br />Water Quality Control Division <br />WQCD-P-B2 <br />4300 Cherry Creek Drive South <br />Denver, CO 80246-1530 <br />METAL MINING STORMWATER DISCHARGE PERMIT <br />REAPPLICATION & RECORD VERIFICATION FORM <br />Colorado Div. of Minerals 8s Geologg Coal Basin Sediment Pond Reclam. <br />This form is for reapplication for the Coal Basin Sediment Pond Reclam. facility (COR-040208) under the Metal Mining <br />Stormwater Discharge Permit. By filling out and signing this farm and returning it to the address at the top, you will have <br />reapplied. In order to reapply by this simplified method, and to avoid a gap in coverage for your facility, you must return this form <br />by July 31, 2006. Do not send any money with this form -the billing process is handled separately. <br />is conramea m me cover terser ana vacr~ mar accompany mrs ronn. <br />'*RETAIN A COPY OF THIS FORM FOR YOUR RECORDS** <br />Ta assist us in improving communication with our permittees, please provide the following email addresses for the following contacts, <br />if available: <br />A. Email of Legally Responsible Person (item 3, below) - <br />PLEASEPROVIDE EMAIL ADDRESS HERE <br />B . Email of Local Contact (item 12, below) <br />__._____ .......__... ...__ .... .........__. .... .....___..._. PEASE PROVIDE EMAIL ADDRESS FARE <br />This is the latest information that we have in our records far your facility. Please review the information carefully and make whatever <br />changes are necessary, by crossing out the incorrect information and writing in the new, and sign the form below. <br />Permittee information, including name ojlegally responsible person who is signing this form: <br />1. Permittee - Colorado Div. of Minerals 8s Geology <br />2. Federal Taxpayer ID Number - 840644739 <br />3. Legally Responsible Person - David L. Buckram, Program Supervisor <br />4. Phone - 303/866-3567 <br />5. Mailing Address - 1313 Sherman Street <br /> Room 215 <br /> Denver, CO 80203 <br />Name, location and description of industrial activity for permitted facility: <br />6. Facility Name - Coal Basin Sediment Pond Reclam. <br />7. Facility Address/Location - Ead of Coal Creek Road <br /> Redstone, CO 81623- <br />8. Facility County - Pitkia <br />9. Latitude - 39/12/00 Longitude - 107/18/00 <br />Mine Status should be one of the following categories, "Active, less than 10 acres'; "Active, 10 acres or more", or "Inactive mine': <br />Inactive mines are mines that are no [anger being actively mined. Mines that are in temporary cessation are considered active. If the <br />status has changed from what is wrinen below, please indicate which one of the three categories is appropriate for [he jaciHty. <br />10. Mine Status - Inactive mine <br />11. Description of Activities -Earth moving, dewatering, device removal, rock spillway <br />construction, and revegetation. <br />Local contact familiar with the site: <br />12. Local Contact - Steven Renner, Project Manager <br />13. Local Contact Phone - 970/241-0336 <br />Stormwater Discharges to: <br />14. Receiving Stream(s) - Dutch Creek tributary to Coal Creek <br />15. To complete this Reapplication, the Legally Responsible Person named above must sign the following certification: <br />/certify under penalty of law that I have personally examined and am familiar with the information submitted on this form and that I <br />believe that the information is true, accurate and complete. Further, I understand that by completing and returning this form, I have <br />applied for coverage under the revised general permit for Stormwater Discharges Associated with Metal Mining Operations And Mine- <br />Waste Remediation (COR-040000) and certified that an up-to-date Stormwater Management Plan is maintained for my facility. <br />Signature of Legally Responsible Person Printed Name Date Signed <br />t .- ° ._ ~ ... ,. --tea, -.. _.. ,_ .~. <br />
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