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GENERAL PERMIT APPLICATION <br />STORMWATER DISCHARGES ASSOCIATED <br />WITH: CONSTRUCTION ACTIVITY <br />(Permit No. COR-030000) <br />For Agency Use Only C O R- 0 3 <br />Date Received: <br />Month Day <br />09 9B <br />Year <br />Billing Code: <br />00 <br />ALL APPLICANTS MUST FOLLOW PART D OF THE INSTRUCTIONS TO COMPLETE THIS FORM <br />Please print or type. All items must be completed accurately and in their entirety, or the application will be deemed incomplete <br />and returned to the applicant. Processing of the application will not begin until all required information is received. Please refer <br />to the instructions for information about the required items. Original signatures for Items 8 and 9 are required. <br />Name and address of the permit applicant (legally responsible entity): <br />Company Name Wagner Rock, LLC <br />Mailing Address 96400E Hwy 40, <br />City, State and Zip Code Craig, Colorado 81625 <br />Legally Responsible Person (application signer) E-mail Address wa nrpcolo@aol.com <br />Phone Number (970) 629-2252 Who is applying? Owner X Developer ? Contractor ? <br />2. <br />3 <br />Local Contact (familiar with facility) Mr jay L Wagner <br />Title President, Owner Phone Number (970) 629-2252 <br />Local Contact E-mail Address: same <br />Location of the construction site: <br />Street Address (or cross streets) <br />City (if unincorporated, so indicate) Craig County Moffat <br />Name of plan, project, or development Wagner Pit <br />Latitude/Longitude (approximate center of the site) - use one of the following formats: <br />Latitude Longitude _ _ - / _ _ / - _ (e.g., 39°42' 11 ", 104°55'57") <br />degrees minutes seconds degrees minutes seconds <br />-or- <br />Latitude 40. 305 Longitude 107. 315 (e.g., 39.703°, 104.933") <br />Degrees (to 3 decimal places) degrees (to 3 decimal places) <br />Legal Description (subdivision, block, and lot) or Map Indicating Site Location/Boundaries: <br />If a map is attached to provide this information, this must be indicated below. Maps must be folded to 8'h x 11 inches. <br />Map Attached? XYes, skip to item 4 ? No; include legal description per Instructions (use separate sheet if needed): <br />Subdivision(s), Lot(s), Block(s): S/2 of the NE/4 Section 6• T6N R90W an 8.20 acre tract - aka parcel 2 <br />4. Area of the construction site: <br />Total area of project site (acres) 8.20 acres <br />Area of project site to undergo disturbance (acres) approximately 7 acres (including stockpile areas) <br />Total disturbed area of Larger Common Plan of Development or Sale, if applicable (i.e., total, including all phases, filings, <br />lots, and infrastructure not covered by this application) 8.20 acres (less 30 foot south and east buffer - approx 7 acres) <br />Application - Page 1 of 2 Revised 7/07