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FOR AGENCY USE OM.Y <br />PROCESS WATER AND STOI2MWATER <br />DISCHARGES ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALl1C MINERALS <br />EXCEPT' FUEL) <br />PERMIT NUMBER <br />C O - <br />DATE RECEIVED <br />YEAR MUNTH DAY <br />TYPE: P S <br />Please print nr type. Do not/a~ttcmpt to complete this fomt beforo reading the inslivctlnns. <br />New G or Renewal G If.enewal, existing petmrt cumber. CO <br />1. Name and address ofpermi[appliunk <br />Company Name: Flatiron C(o~nstructors. Inc. <br />Federal'1'az ' u ur Em I er ID#: ~ ~ Z ¢ s D O Z <br />Mailing Address: p, Q, $OX 2239 <br />City, Store and lip Code: Longmont, CO 80504 <br />Phone Nwnber:f303 1 485-4050 <br />Laval Comaq (familiar w;th faci(ityk Tony Rathbun T;tlo: Project Manager <br />phone NUmber.f 7201 994-8149 Fax No.:f 303t 485-7684 <br />Who is applying for the permit? V Owner G Operator X <br />2. Name and addreav ofproperty owner. <br />Name: Phil Camenish <br />Mailing Address: 3701 Weld County Road 20'-z <br />Ciry, State and Zip Code: Longmont. CO 80501 <br />Pnonc Nnmber.13031 772-0797 Fax Nn.: ( t None <br />J. Location of Ibe faciliTy: <br />Street Address: 3701 Weld County Road 20'-2 <br />city,smmanazipcnae:Lon~cmont, CO 80501 <br />connry: Weld Nmneotfacility- Camenish Borrow <br />Ixgal Location (To~msbiq Range, section, t/4 section): NW a. S 1 5, T 2 N, R 6 8 W O f the 6th P. M. <br />Latitude and Wnghudc: 40 _ 1 3881 N. 1 09.98883 W <br />