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GENERAL PERMIT APPLICATION <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALLIC MINERALS <br />For Aeency Use Onlv <br />COR-50 __ <br />Date Received <br />Year Month Day <br />EXCEPT FUEL) <br />(Permit No. COG-500000) <br />Please print or type. Do not attempt to complete this fdtm before reading the instructions. <br />1. Is this the correM application for your facility?? This application is only for the dischazge of stormwater. <br />Do you discharge any of the following process generated wastewaters from your facility? <br />® No ^ Yes Product wash waters <br />Xn^ No ^ Yes Maintenance/equipment wash waters <br />t~l No ^ Yes Transport waters (e.g., slurries) <br />No ^ Yes Scrubber waters (crushers or classifiers) <br />0 No ^ Yes Mine dewatering (groundwater and/or runoff from the mine) <br />If you answered Yes to any of these questions, do not complete this application. You must instead complete the Process <br />Water and Stormwater Discharges Associated with Sand and Gravel application for this facility, which is available from <br />the Division. <br />2. Name and address of permit applicant: <br />Company Name: Weld County Public k'orks <br />Federal Taxpayer (or Employer) ID#: _g l~ ~ ~ ~ ~ ~ ~ 3 <br />Mailing Address: P 0 Bnx 7 SR <br />City, State and Zip Code: Greele CO 80632 <br />Phone Number: (970 1356-4000 Who is applying for the permit? Owner Operator <br />Loca] Contact (familiaz with facility): Greg Nelson <br />Title: Minin S roerv; sor Phone Number:S 970 ) 356-4000, X 3750 <br />3. Location of the facility: <br />StteetAddress: 39434 WCR 115 <br />City, State and Zip Code: nt n..~es ~ gg~42 <br />Counry: Weld Name of facility: Ashbaugh Pit <br />Legal Location (Township, Range, section, I/4 section): Section 15. T7N_ R59W <br />Latitude andLongitude:_40~ 34' 48.48096" N; ..103 SR' 74_[4030" W <br />Type of Facility: ®New (beginning operations after 10/1/92) ^ Existing (as of 10/1/92) <br />7/93/sg -1- <br />