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1. CONTACT INFORMATION - CONTINUED <br />in accuroance vwm KegUta M 51, an reports required by permits and other information requested by the Division shall be <br />signed by a person described in section 61.4(1)(e) or by a duly authorized representative of that person. A person is a duly <br />authorized representative only if. <br />I. The authorization is made in writing by a person described in paragraph 61.4(1)(e); <br />il. The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated <br />facility or activity such as the position of plant manager, operator of a well or a well field, superintendent, position of <br />equivalent responsibility, or an individual or position having overall responsibility for environmental matters for the <br />company. (A duty authorized representative may thus be either a named individual or any Individual occupying a <br />named position); and, <br />Ili. The written authorization is submitted to the Division. <br />Duly Authorized Representative information provided below? o NO a YES <br />Authorized individual: Doug Morris doug.morris@jbssa.com <br />address: g•morriS@jbSSa.COm <br />Title: General Manager Telephone No: 719-829-4841 <br />Authorized position: Email address: <br />Position currently held by. Telephone No: <br />2. PERMITTED FACILITY INFORMATION <br />Name of Plan. Project or Development: Colorado Beef Reservoir <br />Location of construction site: <br />Street Address (or cross streets): <br />City (if unincorporated, so indicate): <br />State and Zip Code: <br />Latitude and Longitude (approximate rA <br />Latitude: 38/07/17 <br />degrees /minutes/ seconds <br />OR <br />2250 US HWY 50 <br />Lamar county: Prowers <br />CO 81052 <br />inter of site to nearest 15 seconds using one of following formats): <br />Longitude: 102/44/00 (e.g., 39°42'11", 104°55'57") <br />degrees/ minutest seconds <br />Latitude: Longitude: (e.g., 38.703°, 104.933 <br />degrees (to 3 decimal places) degrees (to 3 decimal places) <br />3. MAP (Attachment) <br />Map: Attach a map that indicates the site location and that CLEARLY shows the boundaries of the area that will be disturbed. <br />Maps must be no larger than 11x17 inches. <br />4. LEGAL DESCRIPTION <br />Legal description: If subdivided, provide the legal description below, or indicate that it is not applicable (do not supply <br />Township/RangetSection or metes and bounds description of site) <br />Subdivision(s): Lot(s): Block(s): <br />OR <br />p] Not applicable (site has not been subdivided) <br />5. AREA OF CONSTRUCTION SITE <br />Total area of project site (acres): 66 <br />Area of project site to undergo disturbance (acres): 66 <br />Total disturbed area of Larger Common Plan of Development or Sale, if applicable: <br />(i.e., total, including all phases, filings, lots, and infrastructure not covered by this application) <br />Page 3 of 3 Revised 4/2010