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'10. Date activity i• prtpoaad to eoMnsnu. _ W11hln 3f) dOyS Of ODPfOV01 Date actlvlty Is expected to M owrplatad within 60 days after beginning construction 11. Is any portion o1 the ectivity for whidt authorization is etwpht now tArrplataT ~ YES ®NO ff enawsr i• 'Tee" giw raeaone in the remark eaction. Month end Yax the activity was oomplated Indicate the existing work on the drawings. lb List ell approvals or eertifieetion• ra4rlrad by other ladaral, intsrstete, stets Or local psncisa for any structures, construc- tion, discfieryas, dgoeits or other activities daaeribad in this application. . Iswing Apsnq Type Approval Idanti ficetian No. Dets of Application ~ Date of Approval Colo. Dept. of Water Quafity January 20, 1981 Health Certification li Has any egen~y denied approval for the actiwiry described herein a for any activity directly related to the ectivity descril»d h.rsin7 O Ys^ ®No (11 "Yea" explain in ramarkal 1a. Remarks or additional information. during low flow. A plan view and cross-sections of the equipment pod and the Trovt Creek Channel are attached. As shown on the diagrams, material will be removed from the equipment pad areo to a depth of three feet. This material will be stock- piled so it can be replaced when the site is no longer needed. The pad itself will be constructed of rock of sufficient strength and durability to support a 10,000 gallon water truck and a diesel pump. Along the bank adjacent to the pod, silt may be cleaned from the bottom of Trout Creek to allow the pump suction hose to be placed so that it will be submerged during low stream flow periods. 15. Application i• hereby mods for • permit or permits to authorize the activities deacri bed herein. 1 esrtily that 1 am lemiliar widr the information eontsinad in this application, end that b the beat of my krowladga end belief ouch information is true, mmpl ate, and aearata. 1 further certify that 1 possess the authority o undertake tAs proposed activities. SignsNr o} Applicant or Authorized Agent The applieetim must be signed by the applitprlF howswr, it may ba signed by a duly euthori zed agent (named in Item 51 11 this form is ecoonpanisd M • rtstamant by the applicant designating the spent end agreeing to famish upon reposer, eupplamentsl information in support of the application. 78 U. S, G Section 1001 provides that: Nhoevsr, in any manner within the jurisdiction o} any department or agenry 01 Tha United States knowingly and willfully falsifies, oonesal s, w mvsra up by any Vildr, etitema, w device a materiel 1sq or makes rry fslsa, fictitious Or fraudulent stetamants M raprosentetitwts or makes or uses any letN waiting or doamsnt krowinp same W contain any false fictitious or fraudulent statement ar entry, shall M fined rot more tlran x10,000 or ingriaionsd rot more then live yeera. M bads. Do rot sand ^ permit procasairq fee with this application. Tha appropri ale fee will be assessed when ^ permit (e sawed. REVISED 7/81 ~~ 33