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STATE OF COLORADO) <br /> <br />Deft" ma Oaw-w "MwMa"embWaftaaftwpefcwado <br />l r:0 <br />OM 8 <br />m ? <br /> <br />'t <br />r <br />dn <br />, 8-itt30 <br />Oema, Coaaa 8a „„ <br />• <br />? <br />Rwno (SWI6A22D00 <br />i'tlD lma (?#? T7a0 t rOietR((0 <br />LMetad of (. CofOrBUD p? <br />nrooa?wwodphan+aaoooos afldF v?rt?sn ioa <br />For Agency Use Only <br />Permit Number Assigned <br />COR03- <br />Date Received <br />Month try Year <br />STORMWATER DISCHARGE ASSOCIATED WITH CONSTRUCTION ACTIVITIES APPLICATION <br />PHOTO COPIES, FAXED COPIES, PDF COPIES OR EMAILS WILL NOT BE ACCEPTED. <br />Please print or type. Original signatures are required. This application must be considered complete by the Division <br />before it will initiate permit processing. The Division Will notify the applicant if additional information is needed to complete the <br />application. If more space is required to answer any question, please attach additional sheets to the application form. <br />Applications must be mailed or delivered to: <br />Colorado Department of Public Health and Environment <br />Water Qualify Control Division <br />4300 Cherry Creek Drive South <br />WQCD4L82 <br />Denver, Colorado 00246-9530 <br />PERMIT INFORMATION <br />Applicant Is: a Property Owner o Contractor/Operator <br />1. CONTACT INFORMATION <br />Permit Applicant <br />Company Name: JBS Five Rivers Cattle Feeding, LLC - Colorado Beef <br />Legally Responsible Person: First Name: Doug Last Name: Moms <br />Title: General Manager <br />See description of legal contact item 9, page 3 <br />Mailing Address: 2250 US HWY 50 <br />City, State and Zip Code. Lamar, CO 81052 <br />Phone: 719-829-4841 <br />Email Address: doug.morris@jbssa.com <br />Local Facility Contact ? Same as Applicant <br />Local Contact Person: First Name: Thane Last Name: Milenski <br />Tide: Assistant General Manager <br />Phone: 719-829-4841 <br />Email Address: thane.milenski@jbssa.com <br />Billing Contact ? Same as Applicant <br />Company Name: JBS Five Rivers Cattle Feeding, LLC - Colorado Beef <br />Billing Contact Person: First Name:Thane Last Name: Milenski <br />rdle: Assistant General Manager <br />Mailing Address: 2250 US HWY 50 <br />City, State and Zip Code: Lamar, CO 81052 <br />Phone: 719-829-4841 <br />Email Address: thane.mitenski@jbssa.com <br />Page 3 of 3 Revised 412010