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""T' - , . <br />COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT May 21, 2001 <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 />This form is for reapplication for the Coal Basin Sediment Pond Reclam. facility (COR-040208) under the stormwater general <br />permit for Metal Mining Operations and Mine-Waste Remediation. By filling out and signing this form and returning it to the <br />address at the.top, you will have reapplied. In order to reapply by this simplified method, and to avoid a gap in wverage for your : . <br />facility, you must return this form by June 30, 2001. Do not send any money with this form -the billing process is dandled <br />separately. <br />aoout uus process is contamea m me cover tenet ana vc¢t+tnat accompany uus corm. <br />This is the latest information that we have in our records for your facility. Please review the information carefully and make <br />whatever changes are necessary, by crossing out the incorrect information and writing in the new, and sign the form below <br />*'RETAIN A COPY OF THIS FORM FOR YOUR RECORDS** <br />Permitlee injormalion, including name ojlegally responsible person who is signing thin jor.:t: <br />Permittee - Colorado Div. of Minerals & Geology <br />Federal Taxpayer ID Number - 84-0644739 <br />Legally Responsible Person - David L. Buckram, Program Supervisor <br />Phone - 303/866-3567 <br />Mailing Address - 1313 Sherman Street, Rm 215 <br />Denver, CO 80203- <br />Name, location and description ojindustrialadivityforpermittedjaeiGty: <br />Facility Name - -Coal Basta Sediment Poad Reclam. <br />Facility Address - End of Coal Creek Road <br />Redstone, CO 81623- <br />Facility County - Pitkin <br />Legal Location (Township, Range, Section) -- T-lOS,R-089W,S-10 <br />Latitude - 39/12/00 Longitude - 107/18/00 <br />Mine Status should be one ojthe jollmving categories, "Active, less than 10 acres'; `:4ctive, l0 acres or more'; or "Inactive mine". <br />Inactive mines are mines that are no longer being actively mined Mines tkat are in temporary cessation are considered alive. Ijthe <br />status has changed from what is written below, please indicate which one ojihe three categories is appropriate jor the jaeiGty. <br />Mine Status - Inactive mine - <br />Description of Industrial Activities - Earth moving, dewateriag, device removal, rock spillway <br />construction, and revegetatioa. <br />Local contact familiar with the ske: <br />Local Contact - <br />Local Contact Phone - <br />Stormwater Dueherges to: <br />Receiving Stream(s) <br />Steven Reaper, Project Manager <br />970/241-0336 <br />Dutch Creek tributary to Coal Creek <br />To rnmplete this Reapplication, the Legally Responsible Person named above moat sign the following certification: <br />I 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 hue, accurate and complete. Further, I understand that by completing and returning this form, I have <br />applied jor coverage under the revised general permit jor Stormwater Discharges Associated with Metal Mining Operations and Mine- <br />Waste Remediation (COR-040000). <br />Signature of Legally Responsible Person Printed Name Date Signed <br />