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1 <br />1 <br />1 <br />1 <br />p[t AGENCY U56 ONLY <br />PROCESS VYATER APiD STORMWATER <br />DISCHARGES ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALLIC MINERALS <br />EXCEPT FUEL) <br />•. <br />:;:::: YBAIt ~::..:.... ~ :lIOM9 ~ . :: ..:.:.....:1fAY ... .. . <br />':;7Y~ ~ ~ ! ~t <br />l'Inst print or qpe. Do not attempt b oomplets this form before rtadin; the ioatruetions. <br />]. Name and address of permit appyir~ot: <br />Company Name: CONi4ELL RLSOlikCtS <br />Federal Taxpayer (or P.mploytt) mI: ~ ~ ~ ~ ~ ~ i d L <br />MnilingAddreas: 405 East Harmony Road <br />City, Stain and Zip Code • G~ rr <br />Phone Number :( q 7 n 7 7 i- i l <br />Local Conuet (familiar with 4eiliry): <br />T;t!e: Vice President <br />FuNo.: (q7(1~ 77Z-~lql <br />' 1Vho u applying for Ne permit? ^ <br />2. Name and address of property owner <br />S1 <br />Dave Simpson <br />rr''Phoee Numbers o~ n t ~ ~ z_ z t c t <br />Owner L.~J Operator <br /> Name: NtPX.1n [1PT K r, tia nrlra M (:rant <br />' Mailing AddTSS : d ; n R F n c r r aunt,• Roar.) " ~ ~ <br /> City, Sutra and Ztp Code ;fin rt Cn l l i n a~ rn R n S 7 S <br /> Phone Numbtt :( 1 <br />' Cdy, State and Zip Code: <br />County: La rimer Name of6eility: Wellington Downs Pit <br />LegalLoution(Township, Range,aeaion,l//aeaion): Township 6 North. Range 68 West Section 3,SW <br />WibdeandLongitudr Latitude 40~.i0'30" North Lnn~itnrle 1n4~ Sq'4S" k'PCt <br />' 4. Standard lodustrial CltssifrAtion (57C) Code(s) for Nis faeih'ty. (Include trp b bur, ~ order of ortponanee. Sa Appendix A.) <br />•) 14 4 2 b) 2 9 51 e) d) <br />3. R«dimt Strom: 7be Dune of the rooeivmg atrtamp). (If dseharses b a dtch or storm aessc, abo Delude the Dame of Ne alGrrute <br />~~bgsyr...t Mallard Creek t~~che. La Poudre River <br />sAwn Arm oaAVr,. vv~ 1 <br />' 3. location of the facility <br />Strew Addrus: <br />