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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 A¢enc5' Use Onlv <br />COR•50 <br />Date Received <br />Year >lontb Day <br />EXCEPT FUEL) <br />(F'crmn No COG-500000) <br />Please print or type Do not attempt to complete this form before reading the instruttions. <br />I Is this the correct application far your facility?? This application is only for the discharge of stormwater <br />Du you discharge any of the following process generated wastewaters from your facilny~ <br />~ No ~ S'es Product wash waters <br />~ No ~ Yes Maintenance/equipment wash waters <br />~ No ~ Yes Transport waters (e.g ,slurries) <br />~ No ~ Yes Scrubber waters (crushers or classifiers) <br />~ ~o ~ Yes Mine dewatenng (groundwater and/or runoff from the mine) <br />If you answered Yes to any of these questions, do not complete this apphcanon. 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 />? Name and address of permit applicant' <br />company Name Clear Creek District Water Providers. LLC <br />Federal 'fznpayer (or Hmployer) IDk ? 0 1 4 9 9 3 9 9 <br />A-0athng Address 5460 South Quebec St., Suite 110 <br />City, State and Zip Code Greenwood Village CO 80111 <br />Phone Number (303) 773-1005 Who is applying for the permit' ~ Owner ~ Operator <br />Local Contact (familiar with facility) Robert Lembke <br />Title Manager Phone Number, ( 303) 773-1005 <br />Location of the facility <br />Street 4ddress approx. 5 miles east/southeast of Black Hawk, along SH 119 <br />City, State and Zip Code' _ <br />Cuunn~ Gllpln Name of Taeility MMRR QUarly <br />Legal LocaUOn (Township. Range, section, I/4 secton) Township 3 South Range 72 West Section 26, NE 1/4 <br />Latitude and Longitude 39 degress 45' S9" (N) 105 degrees 24' 48" (W) <br />Type of Facility ~ New ( egmning operations after 10/1/92) ~ Existing (as of 10/1/92) <br />7.1 i,st <br />