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Slormwala I)ivtharges: All adrvr and vucl7~Cnm,rul nnnri uid mill, i.~u.. ~ r ~~. ~,. ,. ~I ~~r x •~~+:rr I.~,nn: 1'!•x xr rnnq,Irlr <br />Appendu C and submit along with the application, (Note: Appendix C u sn Lf'A funs wlal, Apple autr.,n fire prrnru ro Duchargr <br />Stone Water, DurfurrRlr A.vM•in/rA with 6drrrriof Activuy.) Additiorully, new mutealrrtills mud submit a Copy of their Stormwter <br />Martagcmenl Plan with the application. <br />Pollutioo Prermlino Pfaat: Plisse deacrihe any pollution pnvrnlinn or but rtuwgcment plane curtently N pLce whieA mu1J ruult <br />N the improvement of ester quality. Tttce oouW indudc solvent recycling pngnms, material wntamment procedures, eduction, <br />ere, <br />INSTAT T TN(; nTT AUn FriFT CPTT T CON~diA1A0~~P1~ Sl'S $A46~iranrL-c,~~1TEw-p2L <br />SEALS WHERE LEAKS ARE KNOWN, RESEARCHTNG nT44f)rvFn METALS ABSA~~'9fi OR <br />PRECIPITATION PRn(:F.nirRF.S Feu MTATF nr~CgCRr,B_1J,A~,g,P,g.r <br />Hulorie Drimages: Dou historic drainage caul at the site, which u rrol covered under ^ CDPS permit? Yea ® No ^ If w, <br />plwe provide ^ map showing the bcation of the disclurgu and topic o! all analytical infomation on the ducharggu. Plwe sample <br />the dischargu for the panmcten listed N iron 26 cad submit those nauka. Thu requitement may be wived by Ute Divuion if <br />auitabk dais onthe dueharga historic quality and quantityewu. DISCHARGE SAME AS IN THIS APPLICATION. <br />:. Plwe include any other information which you feel the Divuion should be aware o(in dulling tnu permit. Include here any flow or <br />stream data which you would like considered. <br />3. Sgnaturc of Applicant <br />'1 eerily under penalty o(faw that This document and all atlachmenb were p rod under my direction or supervisan in accordance <br />with • system dutgned to cascara That qualified personnel pnperly gatherod and valuated the information aobmdted. Based on my <br />Nquiry of the ppccnan or pcrwto who manegge the systern, or those petsoms directly responsible for gathering the information, the <br />infomation submitted u to Ilrc but o(my knowledge and belie(, true, txunte and complete. f am swan that (here are significant <br />penaltiu for submitting f~4e information, Including llte possibility of fine and imprisonment for knowing vio4lions.' <br /> <br />Gf -~,~ <br />Date Signed <br />of Owner <br />/7 5'E ~. AQ/~/~~~`1//I ~i'L•'S//JtN y L/Y/~ .Z~iVrL-.~'/`/RT/C~t/FJL INI. <br />Name (printed) Title <br />Sigtutun of Operator <br />Date Signed <br />Name (printed) <br />Tick <br />16,.In,{ pLi.uy' App 9N1 <br />