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GENERAL PERMIT APPLICATION For Apency Use Only <br />6 W#-#- V 1%"It r 1 Trr" T"_ o_v} T[ r nr€• <br />VA J.\l V&VV f A LAX L21J<. i 1L11\VLJ <br />ASSOCIATED WITH C O R- 5 n <br />SAND AND GRAVEL PRODUCTION <br />lJi Ll\A11V1\iJ ?Al\-L 11111 L'.[\ - llalG fCel.Gt VCII <br />NONMETALLIC MINERALS Year s?le?nth Day= <br />EXCEPT FUEL; <br />Please print or type. Do not attempt to complete this form before reading the instructions. <br />1. Is this the correct application for your facility?? This application is only for the discharge of stormwater. <br />Do you discharge any of the following process generated wastewaters from your facility? <br /> No Yes Product wash waters <br /> No i Yes Maintenance/equipment wash waters <br /> No Yes Transport. waters (e.g., slurries) <br />t? No e Yes Scrubber waters (crushers or classifiers) <br /> No Yes Mine dewatering (groundwater and/or runoff from the mine) <br />If you answered Yes to any of these questions, do not complete this application. You must instead complete the Process <br />9(T?eie.r a..A iF..r. - a•,n#a: }lins.3x... ?. - ',3} R 4a <br />n -h Sam, } a» -d 3 >T' _ras...?.;-. .a;-..} n...j.f;, <br />. •-?__ -.--.. .. .. ... .... u...... <?.,.,.....o..,.. ..... .pusa <br />the Division. <br />2 <br />Name and address of permit applicant: r,14C 1/WwriI a/ ewl-C <br />t- j>tripany .Name: I X_A'A KL _L A-V-4i > CAT <br />Federal Taxpayer (or Employer) IDW: ri 3 g ? t <br />Mailing Address:: <br />t,f L?', a3LdLG QtILL GIt7 (?VLLG. ?./r'{CG???-.t _ LS(/?.?i/tt.?L?? <br />Phone Number: Who is applying for the permit '61 Owner Operator <br />Local Contact (familiar with facility): M,?. /YJ?iE N <br />Street Address: ( ?YlIL /k2iG?1F_(_ C?vt KO <br />City, State and Zip Code: d764 e"AmAPk ?'?tY:. c ? Name of F lity: rr- ?,{ <br />Legal Location (Township, Range, section, 1/4 section): cqn 1? t ? 74?/ <br />i,at i . i v?igiiuuc?? -a a a Win[ e e f <br />xytx, vl 1'aL;,_iily. lic:w kucgiuruug vj?raYL'tvua ait.?t iva irya7 nx13Y1Ti a5 vi IVr i;7ct <br />7/93/sg -1-