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4 J9 8'0067 C;k N.I:RAI., I'L?lZNl1?[' LICA."I'ION <br />STORNINVATER DISCLIARC ES, <br />ASSOCIATED WITH <br />RECEIVED <br />'JUL 2 4 2009 <br />For Agency Use Only <br />COIL-34 <br />SAND AND GRAVEL PRODUCTION Dtvmw of Reclamation, <br />Miring and Safety OPERATIONS (AND OTHER Date Received <br />NONMETALLIC MINERALS ?'TA -OR <br />Year Month Day <br />EXCEPT FUEL) <br />(Permit No. CUR-340000) <br />Please print or type. Do not attempt to complete this form before reading tile illStl-LICtiOtIS. <br />I . Is this the correct application for ,your facility?? This application is only for the discharge of storniwater, <br />Do you discharge any of the following process generated wastewaters from your facility? <br />Yes Product wash waters <br />IN y Yes Maintenance/equipment wash waters <br />-- . Yes Transport waters (e.g., slurries) <br />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 />NVater and Stormwater Discharges Associated with Sand and Gravel application for this facility, which is available from <br />the Division. <br />2. Name and address of permit applicant: <br />= Company Name: .> ' _7 6 CiL?r.-D st ' 1't Y2 Ld C 404 <br />Federal Taxpayer (or Employer) ID#;"1 <br />nr[ttilin Address: /` <br />(""ity, State and Zip Code: 2 ,. ?iri ?;? ' rr) t 7l i71 <br />t' <br />Phone Number: ('-/A 'A ? {/'-_ Who is applying for the permit? * Owner ? 'Opera ?, t <br />Local Contact (fai„tltar with facility): / ?-•'?)i)+?, .?::,r r)tr? ?e'r <br />t)')'; Phone Number, <br />3. Location of the facility: <br />Street Address: J 1Z i <br />City, State and Zip Code:r t <br />, <br />County: Name of facility: <br />L.egitl Location (Township, Range, section 1/4 section : A, A'•' cS?rSt ?1 _? ;"t' t <br />o <br />Latitude and Longitude: Q?. D3 A ,,l / D4 1 9' Q e 9 ) L- <br />Type of Facility: + New (beginning operations after 10/1/92) ?(`Eaisting (as of 10/1/92)_"s <br />I t Usisg ' / Ci - I !Ff .'1" -,? c./,?lr, /? i /',?.4` j5° <br />LO/Y 01",