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STATE OF COLORADO <br /> <br />adkotoompompmpanamrpiawgam?bam?anae?6ar?maamooeopmao ew* <br /> <br />law ,. . <br />fto"0 0412. 000 <br /> <br /> c,m <br /> <br />For Agency Use Only <br />Permit Number Assigned <br />C01103- <br />Date Received <br />Monts rev 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 De uament of Public Health and Environment <br />Water Quality Control Division <br />4300 Cherry Creek Drive South <br />WQCD-"2 <br />Denver, Colorado 80248-1530 <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: Morris <br />This: General Manager <br />See description of legal contact Rem 9, page 3 <br />Mailing Address: 2250 US HWY 50 <br />City, State and Tip Code: Lamar, CO 81052 <br />Phone: 719.8294841 <br />Email Address: doug.morris@jbssa.COm <br />Local Facility Contact ? Same as Applicant <br />Local Contact Penton: First Name: Thane Last Name: Milenski <br />Title: Assistant General Manager <br />Phone: 719-629-4841 <br />Email Address: thane.milenski@jbssa.com <br />Billing Contact ? Some as Applicant <br />Company Name: JBS Five Rivers Cattle Feeding, LLC - Colorado Beef <br />Billing Contact Person: First Name:Thane Last Name: Milenski <br />Title: 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.milenski@jbssa.com <br />Page 3 of 3 Revised 412010