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• GLiNGRAL 1'ERMI'I' Al'PLIO~'lON <br />S"l'OItMWATI;IS. DISCHARGES <br />ASSOCIATED W11'H <br />SANll ANll G1tAVLL 1'liOllUC1'lON <br />OI'I'sRATIONS (ANll O'111CR <br />NONMi:'1'ALL1C MINI;1tALS <br />LXCLI'1' TULL) <br />(Permit No. COG-5l>Ol)VO) <br />1'Icase print or type. Du not attempt to complete Utis form before reading the instructions. <br />I. Is lltis lire correct application fur your facility?7 1Lis application is only for Ure discharge of slornrrvaler. <br />Uo you discharge a,ty of Ule following process generated wastewaters Crwn your facility? <br />No ^ Yes Product wasB waters <br />No ^ Ycs Maittleuattce/cyuiprnettt wash waters <br />X^ Nu ^ Yes Transport waters (e.g., slurries) ' <br />0 No ^ Yes Scrubber waters (crushers or classifiers) <br />0 No ^ Yes Mine dewatering (groundwater and/or runoff from We mine) <br />if you answered ~e to any of Urese yuestions, Jo nut complete this application. You must instead wmplele Ute <br />Process Water and Slornnvaler llisrltarges Assuclaled with Sand and Gravel application for Uris facility, wlriclt is <br />available trout Ute Division. <br />2.. Nmue and address o[ permit applicant: <br />CompartyName: Sufberland Bros. Inc. <br />Federal Taxpayer (or Employer) IDN: 8? 0 4: 2 :~2 9 4 2 <br />Mailing Address: Post Office Dox 12G <br />City, Stale attd Zip Code: N u c l a, Colorado 814 2 4 <br />Phone Nuutber: f 303 j 8G4-7GG2 Who is applying for the permit? ^ Owner ~ Operator <br />Local Contact (farniliar wiUt facility): r o p Sn t h P r 1 a n d <br />Title: President Phone Nutuber: ( 970 ) 8G4-7GG2 <br />3. localiurr of lire facility: <br />Street Address: DD 25 CO ROAD <br />City, Stale and Zip Code: Nuc1 a . CO 81 4?4 <br />County: Montrose Name of facility: wa; mPr p; r nm ~ _ <br />Legal Lucatiorr (Township, Range, section, 1/4 sectioa): To shin 46 N uangP 1 t; w SQr r ~ SF <br />Latitude attd l,ougiludc: <br />Type of Facility: 0 New (begirwing operations alter 10/l/92) ^ Existing (as of 10/1/92) <br />FOR AGENCY USE ONLY <br />Certification Number <br />C O G- 5 0 <br />Dale Received Fee Glegory <br /> <br />Year MonW Day <br />7/9J/eg -I- <br />