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The name of the receiving waters(s). (If discharge is to a ditch or storm sewer, also include the name of the ultimate <br />receiving water): <br />Unnamed trib. to La Sal Creek, a tributary to Dolores River <br />6. Describe the industrial activities which take place on site. <br />Underground uranium mining (room and pillar). stockpiling of ore and waste rack, and storage and <br />maintenance of mining equipment. No on-site processing (crushing or screening) will occur. <br />7. Stormwater Management Plan Certification: A Stormwater Management Plan (SWMF) shall be prepared prior to <br />applying for coverage under a general permit, and the following certification signed. See SWMP requirements in <br />Appendix B. _ <br />"I certify under penalty of law that a complete Stormwater Management Plan (SWMP}, in compliance with Appendix B of <br />the application, has been prepared for my facility. The SWMP was prepared under my direction or supervision and with a <br />system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my <br />inquiry of the person or persons who manage the system, or those persons duectly responsible for gathering the <br />information, the SWMP is, to the best of my lmowledge and belief, true, accurate, and complete. I am aware that there are <br />significan~nalties for i~mittin~ false information, including the possibility of fine and imprisonment. <br />A <br />/.2 /Z 47 <br />Signature f Legally Responsible Person (submission must include original signature) Date Signed <br /> <br />,~a~%v~.r~- <br />name ~pnnteo) <br />Signature of Applicant <br />Title <br />"I certify under penalty of law that I have personally examined and am familiar with the information submitted in this <br />application and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining <br />the information, I believe that the information is true, accurate and complete. I am awaze that there are significant <br />penalti f ~imitting fal ~e~information, including the possibility of fine or imprisonment. . <br />i /i.. !J7 <br />Signature of Legally Responsible Person (submission must include original signature) Date Signed <br />Name (printed) Title <br />3/07/MM 2 of 2 <br />