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_ _ <br />r 1 <br />L J <br />RA <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTl>'~R <br />NONMETALLIC MIIYERAIS <br />ERCEPT FUEL) <br />(Permit No. COG-500000) <br />~`JG/Q C O G - 3 0 <br />Ci Date Received Fee <br />~ pN~~e9o SOS D. <br />_ c~~( Yesr Moeth r <br />Ptease print or type. Do not attempt to complete this form before reading the ia~tvctiotu. <br />1. Is this the correct app0ation for your fadlity?? Thia appliation is only for the dischazge of stormwates•. <br />Do you discharge any of the following process geaerated wastewaters from your facility? <br />0 No ^ Yd Produtx wash waters <br />X^ No ^ Ya Maintenancelequipmeat wash waters <br />0 No ^ Ya Transport waters (e.g., slturia) <br />© No ^ Ya Savbber waters (crushers or classifiers) <br />© No ^ Ya Mine dewatering (groundwater and/or runoff from the mine) <br />If you answered yg to any of these quatioaa, do not complete this application. You must instead complete the <br />Process Water and Stormvvater Diseltarges Aeaodated wlih Sand and Gravel application for this facility, which is <br />available from the Division. <br />2. Name and address of permit applit9rtt: <br />Company Name: Individual Raymond F. Dellacroce <br />Federal Taxpayer (or Employer) IDx: $ ,~ 1 ~ ~-,~ ~ L L <br />MailingAddras: 2210 Wact Rantict Rnad <br />City, State and Zip Code: Colnrarin Snr!n0s_ re_ A0921 <br />Phone Number: X19 1634-4155 Who is applying for the permit? ©lhwer ®Oporator <br />Local Contact (familiaz with facility): Guenther Polok, P.E. or Mark L. Orbeck <br />Title: Graef Anhalt Schloemer Assoc. Inc. Phone Number: (719 ) 634-6902 <br />3. Location of the fadllt <br />StreetAddras• A~ove Address on prop^rty Ranch ResiAence <br />City, State and Zip Code: <br />County: E1 Paso Name of [acility: nal l~rrnrn f;raval Dit <br />Legal Location (Township, Range, section, 1/4 section): NE Qtr Sec 34 T-11-S R-67-W <br />Latitude and Longitude: 10a-52-30 39-oa-11 <br />Type of Facility: ®New (beginning operations after 10/1192) ^ Existing (as of 10/1192) <br />7/93ha <br />FOR AOfiNCY USfi <br />-i- <br />ii0d E00 S9NI JdS OOH2J0~0~ SF/J 0990 bE9 6I L LI ~ BO BZ-10-b66i <br />