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APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT I OM8 APPROVAL NO. 0710-003 <br />(33 CFR 325) Expires October 1996 <br />Public reporting burden for this collection of information is estimated to average 5 hours per response, including the time for reviewing instructions, <br />searching existing data sources, gathering end maintaining the date needed, end completing and reviewing the collection of information. Send <br />comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to <br />Department of Defense, Washington Headquarters Service Directorate of InlormationOperations and Reports, 1215 Jefferson Davis Highway, Suite <br />1204, Adington, VA 22202-4302; end to the Office of Management end Budget. Paperwork Reduction Project (0710.0003), Washington, DC <br />20503. Plaese DO NO RETURN your form to either of those addresses. Completed applications must be suhmitted to the District Engineer having <br />jurisdiction over the location of the proposed activity. <br />PRIVACY ACT STATEMENT <br />Authority: 33 USC 401, Section 10; 1413. Section 404. Principal Purpose: These laws require permits authorizing activities in, or effecting, <br />navigable waters o} the United States, the discharge of dredged or fill material into waters of the Urrited States, end the transportation of tlredged <br />material for the purpose of dumping it into ocean waters. Routine Usas: Information provided on this lorm~ will be used in evaluating the application <br />for a permit. Disclosure: Disclosure of requested information is voluntary. 11 information is not provided, however, the permit application cannot be <br />processed nor can a permit be issued. <br />One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this <br />application (see sample drawings end instructions) end be suhmitted to the District Engineer having jurisdiction over the location of the proposed <br />activity. An application that is not completed in full will be returned. <br />1. APPLICATION NO. ~ 2. EIELD OFFICE CODE ~ 3. DATE RECEIVED ~ 4. DATE APPLICATION COMPLETED <br />//TFMS RF10W TO RF FlL! FD RY APPL/CANn <br />5. APPLICANT'S NAME 8 AUTHORIZED AGENT'S NAME AND TITLE /sn syenr it nor reovveel <br />Western Fuels - Colorado, LLC <br />6. APPLICANT'S ADDRESS 9 AGENT'S ADDRESS <br />P.O. Box 628 Nucla, Co. 81424 <br />7. APPLICANT'S PHONE NOS. W AREA CUDE 70. AGENT'S PHONE NOS. W AREA CODE <br />a. Residence 303-864-7252 a Res~tlence <br />b. Business 303-864-2165 h. Business <br />11. STATEMENT OF AUTHORIZATION <br />I hereby authorize. Io act in my behalf as my agent in the processing of this application and to <br />lurnrsh, upon request, supp ementa informs io in'su pb df [hrs perrnil application. <br />SIGNATURE G' / GATE <br />NAME, LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY <br />12. PROJECT NAME OR TITLE Isee msvvcuon:I <br />New Horizon Mine - Irrigation Pump Station //1 <br />13. NAME OF WATERBODY, IF KNOWN r~r .ppr%c.erel <br />Calamity Draw-Tributary of San Miguel <br />D ; s~ <br />15. LOCATION OF PROJECT <br />Montrose Colorado <br />COUNTY STATE <br />14. PROJECT STREET ADDRESS lrl.pplics0lel <br />27646 W 5th <br />Nucla, Colorado 81424 <br />16. OTHER LOCATION DESCRIPTIONS. IF KNOWN, )see insrrvcrionsl <br />NW1/4, SW1/4 Section 6 T46n R15w <br />17. DIRECTIONS TO THE SITE 1 &1/2 miles SW of the Clty of Nucla, Colorado. SE of <br />NPDES Pond 007 on Western Fuels-Colorado, LLC. Mine Permit C-81-008. <br />ENG FORM 4345. Feb 94 EDITION GF SFP 91 IS OBSOLETE. roponenl: I <br />