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INDUSTRIAL WASTEWATER DISCHARGE APPLICATION <br /> FOR AGENCY USE <br /> =� APPLICATION NUMBER <br /> DATE RECEIVED <br /> YEAR MO. DAY <br /> Do not attempt to complete this form before reading the accompanying instructions. <br /> PLEASE PRINT OR TYPE <br /> T. Name, address, and telephone number of the owner of the facility producing <br /> discharge. <br /> A. Owner(s) Mid-Continent Resources , Inc . <br /> B. Facility name Coal Basin Mines <br /> C. Mailing address P . 0 . Box 158 <br /> - D. City Carbondale E. State Colorado <br /> F.- County Pitkin County G. Zip Code 81623 <br /> H. Telephone Number (303 ) 963-2581 <br /> Area Code <br /> 2. Is the facility operated other than by the owner? YES X NO <br /> If yes, complete the following: <br /> Operator <br /> Facility name <br /> Mailing Address <br /> City State <br /> County Zip Code <br /> Telephone Number <br /> Also, on the back side of this page describe the relationship, agreements and <br /> time frame of any agreement. <br /> 3. Specify whether owner or operator is making application for the permit. <br /> Owner and Operator <br />