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~ .I`lDUSTRIAL WASTEWATE~ISCHARGE APPLICATION <br />FOR AGENCY USE <br />~ APPLICA710N NUMBER <br />~A <br />DATE RECEIVED <br />YEAR M0. DAY <br />~„~ not attempt [o complete this form before reading the accompanying instructions. <br />PLEASE PRINT OR TYPE <br />NEW '! OR RENEWAL (existing permit No. __) <br />Name, address, and telephone number of the owner of the facility producing <br />discharge. <br />Property owner(s) Ht rli G Cr.. ,,nil Suulhwrst Ii, ,nlv -Plix, Lir. <br />Mailing address 117 4lhi t.~~ Pine Drive <br />~ City Al&mOSa $Ca CC C,~2nr;~tin <br />L) <br />County Alamosa Zip LOde ~}}Ill <br />'~' Name of operation Rich Pit <br />Local con[act(familiar with process) John T. Unyctuy <br /> <br />Telephone Number ( ~~~ ) s8~-slns <br />Area Code <br />2. is [he facility operated other than by the owner? YES < NO <br />If yes, complete the following: <br />Operator Souchwesl Readv-Mix, Inc. <br />Mailing Address 117 Whi Le I'1 nv C)rivo <br />Ci CY /\I ~inu ~„ <br />r <br />County Al~mosa <br />Name of Operation_ <br />Local Contact <br />Telephone Number <br /> <br />John T. UngeC <br /> <br />State C„1.,:-.„7„ <br />i p Code +t] i n1 <br />y Also, on [he back side of this page describe the relationship, agreements and <br />time frame of any agreement. (This information may be designated "confidential") <br />,r ' <br />). Specify whether owner or operator is making application for [he permit. ~ ' <br />