PERMFILE119179

• Permit No: M1994096
• IBM Index Class Name: Permit File
• Doc Date: 11/16/1994
• Doc Name: Stormwater Permit Application
• Media Type: D
• Archive: No

1/16/1994 15:25 302-0390
7
STO ATER ISISCHARCiPS
ASS IATF.D WITH
SAND GRAVEL PRODUCTION
OPERA ONS(AND OTHER
NO ALLIC MITVVERALS
ERC FI)EL)
(Permit N .COQ500000)
CDH WQCD ~C
FAGS 04
FOR wOBNCY USE ONLY
Cersifiatioa Number
C O G- S O
Date Raoaived Acs

Yaac Mmth Dar
PTeaee pant or typo. Do not attempt to complete thL fora before readtog the inetruWom.
I . Js thts~ the erred •ppllptlon Par your fttdlltyTY Thin tlppltptioa ht ady for the discbarge of atarnnvatar.
Do yo~t diadurge any of the followhtg pcocesa gatarated waetewaten from your ficllityf
IIJ}Io ^ Yea Frodua wash water
I
l}lo Yoe Malntenancdequlptneat wash watsra
~la ^ Yee Tranepott watara (e.g., alurrim)
o ^ Yea Scrubber water (exttahen or daaaiflaea)
o ^ Yee Mine dewattYtng (g[ottndwate[ and/or runoff from the tttirte)
Tf you atrawered yffi to any of these queadone, do sot compile tbia appiieatlon. You moat htetead complete the
Water and Stermwata~ Dladuriaa Aaeodated with Sand clad Cravd appliptlon for this facility, which is
avails le $om the DivyiOn.
2.
old addrwe o[ permit appUcant:
Name:
'T'axpayer (or Employer) [DI: ~ ~ 3 ' 4~ ~ = 4' 9 2 Soc ; 4 / S ~ ~ ~"
Atldreas: 1~ a U ~( ~ . C o . ,P ,~ , . S --1 ,,,_
state and zip
~ Number: [=
Contact (familiar with facility):
Phone Number: ( )
3.
uon of the fadliq:
Address: ~2
State and Zip Code:
- -`b -5 / Who is applyigg for the ptttmitT Ibl Owns U Operator
L R Y ,~YN ~r Name
faculty:
Loeadon (Township, Range, seedon, 1/4 teaion):
ie and Longiwdo: ~/ n ° ~/ M ; ., /.
7ypa of Facuiry:
7f43/.a
^ New (beginning operatiutu afttr 10/1/92) VS1 Exbting (ae oP 10/lN2)