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L. Standard Indttstrial Classifetation (Sl Code(s) for this facility. (Include up to tour, to oraer of tmpotnace.) <br />a) S G b) ~ c) ~ d) <br />i. Receiving Stream: The name of the receiving strrxm(s). (lf dixhargc i^ to a ditch or srorm sewer, also include the name c <br />the ultirnrte receiving waters.) LY tu+15 G46G ~ <br />5. Describe the industrial activities which take place on site. <br />HA.1^ OknRR1~lG aF SA^I~STOaJE <br />7. Other Environmental Permits: Does this facility enrrentty have any environmental permits, or is it subjcet h> regulation, <br />under either of the followtag programs:' <br />a) Colorado Di~harge Pcrnit System (COPS or h'PrJES) <br />b) Co!orcdo Mined Lane Recramation Boztd <br />If Yom, include ~1LRD permit annivcrsvy date <br />8. STOR.ISWATER RlANAGEV[E'~T PLAN <br /> <br />~/ Nor (tc r»~EO yEt <br />A Srormweier Slanagamcnt Plan (SWMP) shag be prepared prior m application for coverage under a general p.-rmi[, and the <br />folluur'nb c~-rtific:rian si~cd Sx the SWViP requ+remerts in App~-ldix A. <br />"1 certify under penalty of law that a eomplet` StormwaL-r Managca:ent Plan, in wmpliarce wit}: Appendix A of the <br />application, h:~ been prcpan;d for my facility. Based on my inquiry of the parson or parsons who manage the system, or <br />those pctsons d:ra'tly rr:spoasible forgathering the information, the SWMP is, to the best of my knowledge and bchct; true, <br />accurate, nrd complete. 1 am aware L'1at them an; signifcan2 penalties for falsely certifying the compaction of said SWVIP, <br />including the lvssibility of fine sad imprisonment." <br />SigraAtrc of Permit Applicant <br />Date Signed <br />YYIrCNAEL [ ouuo-IErJ 6M ~ ~P <br />Name (arinted) Title <br />9. Signature of .lpplicant (legally responsible person) <br />"1 cc:5fy under ncntilty of low that 1 have personally examined sad am familiar with the infomtation suirtnitted in this a^,.p'.icatior <br />and a!I attarivncnts and ti[at, 6aS:.d oa my inquiry of those indiv:dtz]s im-ncdiatcly responsib!:: for obtaining the infom~on, 1 <br />believe chat dtc infommtion s true, accurate and comp]ctc. 1 am aw~aic tfu-rt then; arc sigrri£cturt penalties £or submitting false <br />information, including C}r~ possibility of firs and imoricommert" <br />~~,(~~-w <br />-- _ /1-y9- ao <br />Si~rafurc of Permit Appiicant <br />Date signed <br />LEorraA~ t_okKJaE.~ Ow~IErR~ pRfSrA~u'f <br />Nzme (printed) <br />Title <br />