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<br /> <br />• III IIIIIIIIIIIIIIII ~ <br />CONSTRUCTION AGGREGATE <br />INDUSTRIAL WASTEWATER DISCHARGE APPLICATION <br />FOR AGENCY USE <br />APPLICATION NUMBER <br />DATE RECEIVED <br />/ / / / / / / <br />YEAR MONTH DAY <br />Do not attempt to complete this form before reading the accompanying instructions. <br />PLEASE PRINT OR TYPE <br />NEW x OR RENEWAL (existing permit No. ) <br />1. Name, address, and telephone number of the owner of the facility producing <br />discharge. <br />Property owner(s) Sand Creek Farms, Inc. <br />Telephone Number (303 ) 622-9491 or 220-8618 <br />Mailing Address 6312 Fiddler's Green Circle, #535-N <br />Street Address Same as above <br />City Enqlewood, State Colorado <br />County Arapahoe Zip Code 80111 <br />Name of operation Sand Creek Mine <br />Local contact(familiar with process) Bob Fleming <br />Telephone Number C303 ) 450-2204 <br />2. Is the facility operated other than by the owner? YES x NO <br />If YES, complete the following: <br />Operator <br />Mailing Address <br />Street Address <br />CI ty <br />County <br />Name of Operation <br />Local Contact_ <br />Telephone Number <br />( ) <br />Also, on the back side of this page describe the relationship, <br />agreements and time frame of any agreement. <br />S to te_ <br />Zip Code <br />-3- <br />