GENERAL52666

• Permit No: C1981017
• IBM Index Class Name: General Documents
• Doc Date: 7/6/2006
• Doc Name: Metal Mining Discharge Permit-Second Notice
• From: Stormwater Permit Folder
• Permit Index Doc Type: Reclamation Project
• Media Type: D
• Archive: No

COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVII20NMENT July 6, 2006
Water Quali~y Control Division
WQ~D-P-B2
4300 Cherry Creek Drive South
Denver, CO 80246-1530
METAL MINING STORMWATER DISCHARGE PERMIT
REAPPLICATION & RECORD VERIFICATION FORM
Colorado Div. of Minerals 8s Geologx Coal Basin Reclaim. Cons. Pajects
This form is for reapplication for the Coal Basin Reclaim. Cons. Projects facility (COR-040204) under the Metal Mining
Stormwater Discharge Permit. By filling out and signing this form and returning it to the address at the top, you will have
reapplied. hi order to reapply by this simplified method, and to avoid a gap in coverage for your facility, you must return this form
by July 31, 2006. Do no[ send any money with this form - [he billing process is handled sepazately.
aoout mts nrocess is contamea m me cover lever ana ttaca [not accomoanv mts romt.
**RETAIN A COPY OF THIS FORM FOR YOUR RECORDS**
To assist us in improving communication with our permittees, please provide the joUowing email addresses for the following contacts,
if available:
A. Email of Legally Responsible Person (item 3, below) -
PLEASE PROVIDE EMAIL ADDRESS HERE
B . Email of Local Contact (item 12, below)
This is the latest information that we have in our records for your facility. Please review the information carefully and make whatever
changes are necessary, by crossing out the incorrect information and writing in the new, and sign the form below.
Permittee information, including name of legally responsible person who is signing this form:
1. Permittee - Colorado Div. of Minerals 8c Geology
2. Federal Taxpayer ID Number - 840644739
3. Legally Responsible Person - David L. Buckram, Program Supervisor
4. Phone - 303/866-3567
5. Mailing Address - 1313 Sherman Street
Room 215
Denver, CO 80203
Name, location and description of industrial activity for permitted facility:
6. Facility Name - Coal Basin Reclaim. Cons. Projects
7. Facility Address/Location - End of Coal Creek Road
Redstone, CO 81623-
8. Facility County - Pitkia
9. Latitude - 39/11/55 Longitude - 107/18/02
Mine Status should be one ojthe following categories, "Active, less than 10 acres'; "Active, l0 acres or more'; or "Inactive mine".
Inactive mines are mines that are no longer being actively mined Mines that are in temporary cessation are considered active. Ijthe
status has changed from what is written below, please indicate which one of the three categories is appropriate for the facility.
10. Mine Status - Active, less than 10 acres
11. Description of Activities
revegetatioa.
Local contact familiar with the site:
12. Local Contact
13. Local Contact Phone
Stormwater Discharges to:
14. Receiving Stream(s)
- Earth moving, stream channel reconstruction, topsoil application,
- Stevea Reaner, Project Manager
- 970/241-0336
- Dutch Creek tributary to Coal Creek
15. To complete this Reapplication, the Legally Responsible Person named above must sign the following certification:
I certify under penalty of law that I have personally examined and am familiar with the information submitted on this form and that I
believe that the information is true, accurate and complete. Further, I understand that by completing and returning this form, I have
applied for coverage under the revised general permit for Stormwater Discharges Associated with Metal Mining Operations And Mine-
Waste Remediation (COR-040000) and certifed that an up-to-date Stormwater Management Plan is maintained for my facility.
Signature of Legally Responsible Person Printed Name Date Signed