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4. Stvrdard Industrial Classifical~(SIC) Code(s) for Uris facility. (Indudeito four, in order of importance.) <br />a) 1442 b) <br />c) <br />d) <br />5. Raciving Stream: 71te name of Uie receiving stream(s). (If ~tiscltarge is to a ditch or storm sewer, also include Uie <br />name of Use ultimate :eceiving waters.) <br />Sand and Gravel Mining and Crushin g <br />G. Describe llte industrial activities wlriclt lake place on site. <br />7. Oll~er Luvirorttnenlal Permits: Does Utis facility currently Dave any environmental permits, or is it subject to <br />regulation, wider eiUier of the following programs? <br />No Yes Permit ~ <br />a) Colorado Discharge Permit System (CDPS or NPDES) <br />b) Colorado Mined Land Rec:latnation Board <br />if Yg~, include MLRB pennit anniversary date _ <br />8. STORMWATLIt MANAGCMCNT PLAN <br />A Stormwater Management Plan (SWMP) shall be prepared priorlo applicarlort for coverage under a general <br />permit, and the following certification signed. See the SWMP requirements in Appendix A. <br />"I certify under penalty of law U~at a complete Stormwater Management Plan, in compliance wiUt Appendix A of <br />Use application, has been prepazed for my facility. Based on my inquiry of the person or persons wlto manage <br />Ute system, or Utose persons directly responsible Cor gaUtering Ute information, Ute SWMP is, to the best of my <br />knowledge and belief, true, accurate, and complete. I am aware that Utere are significant penalties for falsely <br />certifying Ute completion of said SWMP, including the possibility of fine and imprisonment." <br />4-15-1996 <br />of Permit Applicant <br />Date Signed <br />Lee Sutherland President <br />Name (printed) Title <br />9. Signature of Applirant (legally responsible person) <br />"I certify under penalty of law Wat I leave personally examined and am familiar wiU~ Use information submitted in <br />Uiis application and all attachments and U~at, based on my inquiry of those individuals immediately responsible for <br />obtaining Use information, I believe U~at the information is true, accurate and complete. I am aware Utat Utere are <br />significant penalties for submitting false information, including Ute possibility of fine and imprisonment." <br />Date Signed <br />Lee Sutherland President <br />Name (printed) Title <br />7/93/"g -2- <br />