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~ Submit ~:• .. „ <br />Effe a~, ~, ;:~..;~: ..~~ ~;c~ticn <br />CONSTRUCTION AGGREGATE ~ "~ ~'~ ~ -% <br />INDUSTRIAL WASTEIJATER DISCHARGE APPLICATION <br />' FOR AGENCY USE <br />APPLICATION NUMBER <br />' DATE RECEIVED <br />/ /_/ / / / <br />YEAR MONTH DAY <br />Do not attempt to complete this form before reading the accompanying instructions. <br />PLEASE PRINT OR TYPE <br />NEW x OR RENEWAL (exist.ing permit No. ) <br />' 1. Name, address, sad telephone number of the owner of the facility producing <br />discharge. <br />' Property owner(s) United Companies of Mesa County. Inc_ <br /> Telephone Number (303 ) 243-4900 <br />' Mailing Address P 0 Box <br />S <br />Add 3609 <br /> treet <br />ress 618 Dike Road <br /> City Grand dnnrti nn State Cnlnradn <br /> County Masa Zip Code 81502 <br /> Name of operation Virgin ia ArrPC Fir <br />' Local contact(familiar wit h process) Paul McGehee <br /> Telephone Number ( 303) 243-4900 <br />' 2. Is the facility operated other than by the owner? YES g N0 <br /> If YES, complete the following: <br />' Operator <br /> Mailing Address <br /> Street Address <br /> City State <br />' County Zip Code <br /> Name of Operation <br /> Local Contact <br />' Telephone Number ( ) <br />' Also, on the back side of this page describe the relationship, <br />agreements and time frame of any agreement. <br /> <br />