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j' - Item 3 - For the approximate cent~oint of the property, both types of desct~ons (legal, in terms of <br />': Township, Range std S4 section, and longitude/latitude, to the nearest 15 seconds) must be included. <br />This information is easily obtainable from a U.S. Geological Survey topographical map, available at <br />area tttap stores. <br />Item 4 - The Standard Induatrlal Classi8catioo (SIC) Code or codes for the facility must be listed. SIC Codes <br />are issigned according to the primary activities performed by a company. They aze often usigned for <br />insurance purposes or when a business registers u a corporation. Industries can also determine their <br />SIC Code by checking with thou trade usociation, Chamber of Commerce, legal counsel, or local <br />library for the SIC Manual. See Appertdtx B. <br />Item 5 - Iden[ify the receiving water. Receiving waters are any waters which aze contained in or flow in or <br />through the state of Colorado (except for water withdrawn for use until use and treatment have been <br />completed). This definition includes all water courses, even if they aze usually dry. <br />If stotmwater from the industrial site enters a storm sewer system or ditch, identify that system and <br />indicate the ultimate receiving water for the storm sewer or ditch. Note: a stormwater discharge permit <br />does not allow ~ discharge into a ditch or municipal storm sewer system without the approval of the <br />owner/operator of that system. <br />Item 6 - Describe the primary irdttstrial activities at this facility, such u mining, gravel wishing, crushing, or <br />batch plain operations. <br />Item 7 - Indicate whether or not your facility has or is subject to the following environmental permits: <br />a) If you cuaently have a dischazge permit from the Division for the dischazge of process water, <br />include the number here (CDPS -Colorado Discharge Permit System; NPDES -National Pollutant <br />Discharge Elimination System). Note that if yotu operation is currently covered under the <br />Division's general permit for sand and gravel operations (permit number COG-500000), then you <br />do not need to fill out this application. <br />b) Indicate your Mined Land Reclamation Boazd permit number here. The anniversary date of your <br />mining permit application to the Colorado Mined Land Reclamation Board is also required. <br />Item 8 - Completion of a Stormwater Managemetu Plan (SWMP) is required prior to application. (Submittal of <br />the actual plan is not required.) The permit application stall include a sigr-ed certification that the <br />SWMP has been completed. For a detailed list of SWMP requirements, see Appendix A of the <br />application. <br />Item 9 - The application moat be signed to be considered complete. In all cases, it shall be signed is follows: <br />a.) In the case of corporations, by a principal executive officer of at least the level of vice-presidem or <br />his or her duly authorized representative, if such representative is responsible for the over-all <br />operation of the fuility from which the discharge described in the application originates. <br />b) In the case of a partnership, by a general partner. <br />c) In the case of a sole proprietorship, by the proprietor. <br />d) In the case of a municipal, state, or other public facility, by either a principal executive officer, <br />ranking elected official, or other drily authorized employee. <br />~imiss -ii- <br />