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<br />. NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM '.° "
<br />APPLICATION FOR PERMIT TO DISCHARGE -SHORT FORM C :.
<br />To be filed only by persons engaged in manufacturing and mining '
<br />• Form Approved
<br />OMB No, l58•R0096
<br />• .APPLICATION NUMBER
<br />FOR
<br />AGENCY
<br />USE - GATE RECEIVED
<br />' ~ ~ ° YEAR "" • MO.~ - - DAY '
<br />" : ,_.
<br />Do not attempt"to complete this form .before reading accompanying instructions ~" ~ ~~ - "" '
<br />- Please"print or type ~~ ~ ~ - ~-• ~ ~ ~ -- ' ~ •
<br />1.Name; address,'~iocation, and telephone number ~of-facilify' producing discharge:' ~-:: ~" ~ "' ~ "- -"' -'" ~" " "~ '"
<br />- .-" "A. Name 'Corn Construction Co. '
<br />B. Mailing~addres5- ~ - .- •.~ ~- :. , ~. ~ :~~ - ~: ~ _ .. ",
<br />1. Street address P • 0. Box 1240
<br />-.... _ p. City Grand Junction, ,__, _,_ 3...State, Colorado
<br />--- - 4. County Mesa ~ 5• ZiP ~ 81501 ~-~ - ~ ~~
<br />... ,_.
<br />C. Location: ., .. .._ _ _. .. _ ....., .._.._ - -_ "
<br />,.._... 1. Street North Delta-Pit (Annroximately 2 miles northeast of "Delta)' `
<br />~.. 2. City ~ Delta ~ 3, County Delta ~...., ~ , .- ,
<br />4. State Colorado ""' ~ '
<br />.. .. ,.
<br />D. Telephone Nor 303 ' 242-3380 _
<br />Area ' .. , ...:..._ `° - .... ~ - - ..._- .. '...._ ..~._ .._._.. ...._ _ .. __._.._.. _ .. .
<br />" Code ~ .. - .. .. -. ~ _
<br />- .. _
<br />2.. SIC.. - .. _ _
<br />~: ~ -
<br />(Leave blank) _ -
<br />~3.~Number~~of"employees ~~ ~ ~$ ~ ~ .~ ~ ~ "' ~ • '~`"~~-
<br />If all:your waste is discharged into a publicly.owned,weste treatment facility.,,;::,-_ __ ~ ___ _ ~ _ _
<br />'- and to the best of your knowledge you are not required to obtain a discharge ~ ~. ~, ~~", ., "_, ,. ~"... .
<br />' ~• 'permit, proceed to~ item 4, Otherwise proceed directly to~item~5~,---•~~--- - - ~" ~-•~-~---------.--~_--~---~ - -~-~ --- "~•~-~
<br />= 4. If~you meet the condition stated.;above, check here~o and supply the information""" -- "' °- ~- "--"-'°-"'"`
<br />-.. . .
<br />~~--- asked for below. After.complebing these~i2ems,.pleas~-complete the date, title, ._ -.. .. ...,_":-_::::._.~,..;~.. '
<br />_ and signature blocks below and return this-form.toahe properreviewing office - ~. ~..• -.• - ..
<br />~~~ -without compleiing.the.remainder of the .forte..-~-~:~~~~ -'" ' "" ~'-"~ " ~"--""""'-~ ~`~~"
<br />-_ _ A. Name-of organizationrresponsible.for receiving waste
<br />6; Facility receiving-wastec~`~ ~ " """"_" "" ~ -- ~ .___ _ _.__ _, ______.__....__ _
<br />.... ,. .,
<br />1. Name - .. - ..
<br />2, Street address ~ "~~~~ " -" - "~ ~- ~ ~-
<br />. ._. .. ,
<br />3. City - ~- _...4. County
<br />-... 5. State :..- :. ,,.~ _ .. _ ....~ -. 6'. ZIP..
<br />~,,.fl Pr.inci pal .product,~raw ma terial~(Check~one)-- Sand~and ~gzavel ~ ~ - '"
<br />_. r6. Principal process Crushing" sand and....gradel ~ ~ _
<br />`~"): Maximum~.amourtt-of principal ,product produced or~raw mateciel~con sumed per.; (Check one) ~~ --. "
<br />Amount
<br />^ : _..
<br />Basis 1-99
<br />_.:_. _. 100-199
<br />... -- 200-499
<br />_".... 500-999 1000-
<br />4999 .. 5000-"
<br />....9999-- 10,000-
<br />-49.999.. 50,000
<br />....or more
<br />A. Day - -
<br />B, Month -- ~ - ~- - ~ ~ ~ '
<br />C. Year ~ ~ ~ -. ~XXX ..
<br />EPA.Ferm 7550-8 (Rev. 3-7!) ~"".~ ~ ~ ~ - ~ " ~ - ~ -~ " -~ -" " `
<br />PREVIOUS EDITION MAY'' BE USED UNTIL SUPPLY IS EXNA USTED - - '"'
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