PERMFILE100453 - Laserfiche WebLink

Home Browse Search

GENERAL PERMIT APPLICATION STORMWATER DISCHARGES ASSOCIATED WITH SAND AND GRAVEL PRODUCTION OPERATIONS (AND OTHER NONMETALLIC MINERALS EXCEPT FUEL) {Permit No.COG-500000) For Aeenev Use Only COR-50 Date Received Year Month Day Please print or type. Do not attempt to complete this form before reading the instructions. 1. Is this the correct application for your facility?? This application is only for the discharge of stormwater. Do you discharge any of the following process generated wastewaters from your facility^ ~ No ~ Yes Product wash waters ~ ~ No ~ Yes Maintenance/equipment wash waters ~ No ~ Yes Transport waers (e.g., slurries) ~ N ~ Yes Scrubber waters (crushers or classifiers} ~ No ~ Yes Mine dewatering (groundwater and/or ntnoff from the mine) If you answered Yes to any of these~questions, do na complete this application. You must instead complete the Process Water and Stormwater Discharges Associated with Sand and Gravel application for this facility, which is available from the Division. 2. Name and address of~per~mit;a~pplicant: /'~ Company Name: \ 1, `. (), ~/tJ~ (,.~i~cf~{{ Federal Taxpayer (or Employer) IDIt: 2- ~ ~ b ~ O O_ 7 z Mailing Address: ~ ~, la~X 8 Jr- City, State and Zip Code: ~ Z 3 ~ Phone Number. (3D7) .fig -6~OQ Wh is applying for the permit? n Owner Operator Local Contact (familiar with facility): /'7~R, J~tC ~/2~~ q Title: ~/~~OF/6+!- ~ .~ ° D Cj~,s,~Q. Phone Ntunber: ( 7) 38~- ~rl / ~ 8 3. Location of the facility: e Street Address: l !mil/L ~ X.~rfH D F S ~"~ ~ c~`ti- C ~ # City, State and Zip Code: S l,~'T~~i (*.Q~ ~ ~ (~~ County: ~ DFt=/( (~ Natue of facility: _ ~j t-~-~ ~~/~/ ~ ~ - - d Legal Location (Township, Range, section 1/4 section): ~/ZtV ~89~'/ ~E~t i{/ ' ~I Latitude and Longitude: /~`'4O ~ 0 94/ W lO7 z2 ~ 9Y6 Type of Faci~ a New (beginni~g operations after 10/1/92) a Existing (as of 10/1/92) 7/93/sg