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08(26/1999 08:17 303-782-0390 CDH WOOD WQCC PAGE 03 <br />6 Iksa,iba the hadYo~ial aetlddas which take piax an site. EARTB MOVING, DEWATERING <br />' DEVISE REMOVAL, ROCK SPILLWAY CONSTRUCTION, REVEGETATION <br />Other Faviroa~al Patmi~: Does this fseiitry wauuly have auy ettviratmumtal permits. or is it subject to <br />reguluion, Hader mY of the following programs? <br />a) Colorado Diarbarge Permit Sysmm (COPS or NPDES) <br />b) Resource Causervation sad Recovery ACt (RCRA) <br />- If ]'~,, ie Your facility a Ttrsuamt. Storage or Disposal facili<y!~ <br />c) Colorado Division of Mimtals sad Gmology (formerly MLRD) <br />d1 Strperfimd Ame:~mts sad Reauthoriastioa Ad (SARA), T'ak III <br />(F^^~g-~ ~ Plarmiag a>d Coooanmiry Right-co-Know Act), Section 313 <br />a) Hoary 7. I36bt Jndtr~, bBdoQ: a Stormwuer Mmageatem Plan (SWMP) shall be prepared prior to <br />applying for coverage under a general permit, and the foltowittg eertillcsdoa aigaed. See SWMP tegttiremmtr is <br />Appendix B (Light sad Heavy hxlwary) or Appendix C (Mining). <br />NOTE: Hoch' Item B sod ! t~ be tl~d is ordee for the appile~ioa to be peneassad. <br />8. Btormwatar M~ Pltta <br />4~ P <br />and evaluate the in6ornution submitted. Bated on trry inquiry of the person Or pttsom who matuge the sY~. <br />err those persons directly napoosibta tot gathering the info~stion, the SWMP ;a, to the beat of my lmowledge <br />ata3 belief, true. amreue, and eta I am aware that there are aigmficaat penahies for submttaing false <br />intormuioa, htciuding_t)p~p~b' yy of fine sad itaprisammeut.• <br />'I Certify under of law that a campiae Stotmwaur Managsarent Plea (SWivlP), in Coalpliaace with <br />Appetsiix `~~ (date one) of the. application, has bees prepared for trry facility. The SWhIP was prepared <br />under ray or supervision ltnd with a syttetn desigtred to ataae tbu t~lY 8~ <br />Sigaautre of )fit Appllcam <br />iii~wYeS PermlfX or IDN ~~~ <br />$; 000000 396 <br />x _ <br /> <br />R ,~ <br />Date Signed <br />STEVEN G.RENNER ~ PROJECT MANAGER <br />Name (printed) Title <br />b) Hest Indtutq: the permittee shall also submit a cagy of the 5WMP to the Division with the permh application. <br />SWMP aaelased? ^ No ^ Yea <br />9. of APplteaat (~Y *rP~a pub <br />'I certify sender penalty of hw that I have petsoaaIly examined and am fsaailiar with the information submitted is <br />this applitxdon sad all sttachmmts sad tent, baron on ary ittgttiry of tense iodividoals wmediaoely respaosibte t`or <br />obtaittiag the information, I believe that the iafotuntioa is ttne, ~,*~• sad oousplete. I am aware Chu there ere <br />fides for sabmitdag false informuiaa, inchtding the posnbility of fine and httptiso~tem.' <br />Sigtuuure of Permit Appliomt Date Signed <br />DAVID L.BIICRNAM PROGRAM SIIPERVISOR <br />Name (printed) Title <br />~r9anhm <br />-2- <br /> <br />