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6. Describe the industrial activities w,..ch take place on site. GOLD ORE 1•,_.dING, UNDERGROUND <br />OPERATION <br />7. Other Environmental Permits: Does this facility currently have any environmental permiu, or is it subject to <br />regulation, under any of the following programs? <br />a) Colorado Discharge Permit System (CDPS or NPDES) <br />b) Resource Conservation and Recovery Act (RCRA) <br />- If Yes, is your facility a Treatment, Storage or Disposal facility? <br />c) Colorado Division of Minerals and Geology (formerly MLRD) <br />d) Superfund Amendments and Reauthorization Act (SARA), Title III <br />(Emergency Planning and Community Right-to-Know Act), Section 313 <br />No Yes Permit# or IDIi <br />~ CO-(1043877 <br />X <br />X Pt-78-091 <br />-~ - <br />NOTE: Both Items 8 and 9 must be signed in order for the application to be processed. <br />8. Stormwater Management Plan <br />a) Heavy Industry, Light Industry, Mining: a Stormwater Management Plan (SWMP) shall be prepazed prior [o <br />applying for coverage under a general permit, and the following certification signed. See SWMP requirements in <br />Appendix B (Light and Heary Industry) or Appendix C (Mining). <br />"I certify under penalty of law that a complete Stormwater Management Plan (SWMP), in compliance with <br />Appendix B / C (circle one) of the application, has been prepazed for my facility. The SWMP was prepared <br />under my direction or supervision and with a system designed to assure that qualified personnel properly gather <br />and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, <br />or [hose persons directly responsible for gathering the information, the SWMP is, to the best of my lmowledge <br />and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false <br />information, including th~o~,sibility of fine and imprisonment. <br />of Permit Applicant <br />Q~ '! `Ja <br />Name (printed) <br />Title <br />b) Heavy Industry: the pertnittee shall also submit a copy of the SWMP to the Division with the permit application. <br />SWMP enclosed? ^ No X^ Yes <br />9. Signature of Applicant (legally responsible person) <br />"I certify under penalty of law that I have personally examined and am familiaz with the information submitted in <br />this application and all attachments and that, based on my inquiry of those individuals immediately responsible for <br />obtaining the information, I believe that the information is true, accurate and complete. I am awaze that there are <br />significant pei}ties foy~[nbmitting false information, including the possibility of fine and imprisonment." <br />e of Permit Applicant DaEe Signed <br />Name (printed) Title <br />7/96/Ihm -2- <br />