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GENERAL PERMIT APPLICATION <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH <br />(• METAL MINING (Permit No. COR-040000) (and <br />some Coal Mining - see Instructions) <br />For Agency Use Only C O R- 0 4 <br />Date Received: <br />M;wh tray Ycu <br />ALL APPLICANTS MUST FOLLOW THE DIRECTIONS FOR COMPLETION OF THIS FORM IN <br />PART C OF THE INSTRUCTIONS <br />Please print or type. All items must be completed accurately and in their entirety or the application will be deemed incomplete <br />and the application returned. Processing of the application will not begin until all information is received. Please refer to the <br />instructions for information about the required items. Original signatures for Items 7 and 8 are required. <br />Name and address of the permit applicant: <br />Company NameDt4?,S'on (rlATys (USA) Co{P. <br />Mailing Address 1050 "JterotYA Sr(Yu - , Skt.. _1 50 <br />City, State and Zip Code :bAd.ve,. l.Olorcc,Lo 967_Io5 <br />Phone Number (36) Who is applying? wner Operator <br />Local Contact (familiar with facility) __T)anntA T?rtneru <br />Title __(II?;nA??tav.,r?l:w?cC'lP_(?vu?ri Gn Phone Number (485) (PI-8 , 6(21 _ <br />Local Contact E-mail Address d pAantne!2l6 ;sonyvapts .C&LA- <br />• Legally Responsible Person (application signer) E-mail Address .fJbuck @C{ensonryunes . Cavtti- <br />2. Location of the Facility: <br />Street Address SeC'+'-V" 2-q -7" q(. ^I t 21-- w 0r(.6na new. riles.) <br />City, State, and Zip Code (201 V'-.to <br />County Majq*ms . Name of Facility 1'0.n +-? Sjka_f - <br />Latitude/Longitude - use one of the following formats: <br />Latitude 38"1 12' / q 3 ' Longitude t o o / y 11 39-42'11 ", 104°55'57 <br />-or- degrees minutes seconds degrees minutes seconds Latitude _d Longitude (e.g., 39.703°, 104.933°') <br />egrees (to 3 decimal places) degrees (to 3 decimal places) <br />3. Standard Industrial Classification (SIC) Code(s) for this facility. (Include up to three, in order of importance.) <br />a) 161q b) c) <br />4. Permit Category: Under which mining category does this facility belong? (See Appendix A.) <br />etal Mining Coal <br />Mine Category: Which category is your facility under? <br />Active mine, less th=Oacxcs? Active mine, 10 acres or more Inactive mine <br />\. Colorado Division of Reclamation, Mining and Safety Permit Number (if applicable): <br />3/07/MM 1 o172