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1 <br />1 <br />1 <br />1 <br />Please print or type. Do not attempt to complete this form hefore reading the instmctiom. <br />New ®or Rencvral ^ H renewal, existing permit number: CO <br />1. Name and addrns of permit applicant: <br />CmopanyName: Roaring Fork Resources, inc. <br />Federsl7axpaycr (a Employer) IDN:B 4 1 1 6 ~, ,~ 4 4 <br />' Mailing Address: 14156 B Highway 82 <br />Ciry, State and Zip Cade : Carbondale , CO. 81623 <br />Phooe Numba~(970 1963-0110 <br />' local Contxt (familiar with faciliryJ• John Martin <br />Phone Number. (970 t 963-0110 Fax <br />' Who is applying for the permitT ^ Owntt ®Operator <br />2. Nome and address of property owner. <br />' Name: <br />Mailing Address: ~_ <br />' City, State and Zip Code <br />FOR AGENCY USE ONLY <br />' Phone Ntwbtt : ( t Fax No.: ( 1 <br />3. Location of the IaeBlry: <br />' Street Addmss• <br />Ciry, State and Zip Code: <br />I County: Garfield Namenffacility ~~ Creek Sand & caravel Pit <br />legal Location (Township, Range, section, I!~ settion} T6S R93W S 11 ,12 ,13,1(+ _ <br />I L,hmacatdLongih,~:Latitude - 39a 31` 58° N Longitude - 10y° 43' S9" W <br />I <br />See Attached List <br />PROCESS WATER AND STORMWATER PERMfI' NUMBER <br />DISCHARGES ASSOCIATED WITH C o <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER DATE RECEIVED <br />NoNn>ErALLIC nlnvERAIs <br />ExcEPr FuEL> - <br />YFAR MONTH DAY <br />TYPE P S <br />