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n. <br />4. J?iHOii'Q l0'{?l [ :19tQfsKnrr ?CYY`1 ,1?....w <br />14 4 -7 s .va ., rac;iiity. (10clude up to four, m order of importance-) <br />a? Fir <br />tl n Stremn: T'he name of re=,v smmn(s). (If disckarge is to a ditch or storm seawer, also include the name of <br />the nltifnate jecetvmg waters.} <br />Ulj <br />A-M JOT lea <br />6. tJh? <br />- activit W,b" take place on site. j <br />,f?x'f TCyC ti ?»E,?s ?12v _ nA-j /1--y -q <`A* ,n //?f. PU94 1til, <br />7. Other l rviraW&eKtai Ptr>1A-s Does this %cilgy eerreatly have any environmental permits, or is it Sect to regulation, <br />U-1cr per of rite following Programs? <br />Nn YPa D,?.,:i it <br />a) Colorado Discharge Permit System (CDPS or NPDES) ••••_?r?•?®? <br />b) Coloraclc, MnM t nut 77 <br />• s <br />If X-M iududa MLAB permit anni - <br />vasatY date <br />8. 9r0RMWATM MANAGMWNF Pi AN <br />A Staemvvatcx lianWMM plan (S p) xk&g be p snd p?ios 90 VPNcmddm for coverage under a general permit and the <br />following certification tamed See the SWMP MWumumts, is Appendix A <br />"1 cutify ttttder PO"Y of lave that a corr>phAe Sties Management Plan, m compliance with AWend x A of the <br />apphc Won, has been pnvared for my facility. Based an env mquiry of the e-- ; or who ,:,aaW the, syv-m , of <br />those Persons directly RaPonsible far gathering. the information, the. SWMP is, to the best of-my knowledge and belie, true, <br />acct and couple . I am ham-re .t.- t? ? ai ' Fcam pa"mum for Wady c omfying the completion of sad SWU P, <br />including the ply of Sne and imprisonment.--4- 1 <br />. <br />3©_Qb <br />8igr a of Pertait Applicant. Date Signed <br />?tc?i r- <br />Name (petntod) Title <br />9. Srg"Wre of A.ppbeaet (tegai responsible person) <br />"I cel* under penalty of lave that I have persoa dly weed and am &,,hsr with the information submAted in this Whcaum <br />& Y vesponsa'k ff <br />and all attachmeam athu. based my mc1miry of timse Mr <br />muneffiaMel obtaining the infatmatien, I <br />believe that the info =&On m true. aecurette and c omnlet,. i arm Ww&, tha tb_a f0f Submitting false <br />information, including the poay.of dine and impriso° <br /> <br />Sigimtiiie of Permit Applicant <br />Date Signed <br />N9= <br />Title <br />7/93 ft <br />-2-