PERMFILE111251

• Permit No: M2003091
• IBM Index Class Name: Permit File
• Doc Date: 6/30/2004
• Doc Name: CDPS Permit Appl
• From: Lafarge West Inc
• To: CDPHE
• Media Type: D
• Archive: No

FOR AGENCY USE ONLY
PROCESS WATER AND STORMWATER ~ PERMTT NUMBER
DISCHARGES ASSOCIATED WITH C O .
SAND AND GRAVEL PRODUCTION
OPERATIONS (AND OTHER DATE RECEIVED
NONMETALLIC MINERALS
EXCEPT FUEL)
YEAR I MONTH I DAY
TYPE: P S
Please print or type. Do not attempt [o complete this form before reading the inswctions
New ® or Renewal ^ If renewal, existing permit number. CO
I. Name and address of permit applicant:
Company Name: Lafazge Wes[, Inc.
Federal Taxpayer (or Employer) IDrY: 25-1531295
Mailing Address :1590 W. 12`" Avenue T
City, Stale and Zip Code : Denver, CO 80204
Phone Nttmber : [phone]
Local Contact (familiar with facility): Phillip Couttnev Title: Environmental Eneineer
Phone Ntunber: (303) 6574118 Fax No.: [phone]
Who is applying for the permit? ^Owner ®Operator
2. Name and address of property owner:
Name: C/0 Lafar¢e West. Inc.
Mailing Address :1590 W. 121h Avenue
City, State and Zip Code : Denver, CO 80204
Phone Nttmber : [phone] Fax No.: (303) 6574339
3. Lacatlan of the facility:
Street Address: Countv Road 20 'h
City, State and Zip Code: Lonmtont. CO
County: Weld Name of facility: Duckworth Pit
Legal Location (Township, Range, section, t/4 section): NE '/.. S 16 R68W. T2N
Latitude and Longitude:
4. Standard Industrial Classification (SIC) Code(s) for this facility. (Include up to four, in order of importance. See Appendix A J
a) 1442 b)
c) d)
5. Receiving Stream: The name of the receiving s[ream(s). (If discharge is to a ditch or storm sewer, also include the [tame of the ultimate
receiving wa[ers.) Idaho Creek 3c Lieh[house Cove (private lake
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