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GENERAL PERMIT APPLICATION <br />STORMWATER DISCHARGES <br />ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALLIC MINERALS <br />EXCEPT FUEL) <br />For Agency Use Only <br />COR-50 <br />Date Received <br />Year Month Day <br />(Permit No. COG-500000) <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 />R1 No ? Yes Product wash waters <br />?1 No ? Yes Maintenance/equipment wash waters <br />VN o ? Yes Transport waters (e.g., slurries) <br />VN o ? Yes Scrubber waters (crushers or classifiers) <br />0 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 />Water and Stormwater Discharges Associated with Sand and Gravel application for this facility, which is available <br />from the Division. <br />2. Name and address of permit applicant: <br />Company Name: ? ?j ft6w ,- ? u C'N' LU2, <br />Federal Taxpayer (or Employer) ID#: <br />Mailing Address: <br />City, State and Zip Code: <br />Phone Number: (9 7e)) 970 Who is applying for the permit? ® Owner ® Operator <br />Local Contact (familiar with facility): <br />Title: rhf-VAlk"t- Phone Number: (4W <br />3. Location of the facility: <br />Street Address: /O`5-0 ?'- -'/ -5-" ?4ve? <br />City, State and Zip Code: <br />County: Name of facility:' <br />Legal Location (Township, Range, section, 1/4 section): sAk 42'? I V41-4" -Ii6 Lld .0m). > 2 .? <br />Latitude and Longitude: GAp ?- <br />-07 <br />Type of Facility: New (beginning operations after 10/1/92) ? Existing (as of 10/1/92) <br />7/93/sg -1-