2009-12-30_PERMIT FILE - M2010002

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5. Nature of the construction activity: Check the appropriate box(s) or provide a brief description that indicates the general nature of the construction activities. (The full description of activities must be included in the Stormwater Management Plan.) ? Single Family Residential Development ? Multi-Family Residential Development ? Commercial Development ? Oil and Gas Production and/or Exploration (including pad sites and associated infrastructure) ? Highway/Road Development (not including roadways associated with commercial or residential development) X ? Other, Describe: Extractive Industry, gravel processing 6. Anticipated construction schedule: Construction Start Date: 6 /1 /2008 Final Stabilization Date: 6 /1 / 2023 month day year month day year The name of the receiving waters(s). (If discharge is to a ditch or storm sewer, also include the name of the ultimate receiving water): no discharge all stormwaters contained onsi a in excavation area STOP! A Stormwater Management Plan (see Appendix A) must be completed prior to signing the following certifications! 8. Stormwater Management Plan Certification: "I certify under penalty of law that a complete Stormwater Management Plan, as described in Appendix A of this application, has been prepared for my activity. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the Stormwater Management Plan is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for falsely certifying the completion of said SWMP, including the possibility of fine and imprisonment for knowing violations." z-e.1o Signatu f Legally Respon le Person (submi ion must include original signature) Date Signed Mr. Jay L Wagner President Name (printed) Title 9. Signature of Applicant "I certify under penalty of law that I have personally examined and am familiar with the information submitted in this application and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine or imprisonment. "I understand that submittal of this application is for coverage under the State of Colorado General Permit for Stormwater Discharges Associated with Construction Activity for the entirety of the construction site/project described and applied for, until such time as the application is amended or the certification is transferred, inactivated, or expired." Signatur f Legally Res risible Person (s mission must include original signature) Date Signed Mr. Jay L Wagner President Name (printed) Title Application - Page 2 of 2 Revised 7/07