2011-01-24_PERMIT FILE - M2011007 ‎(11)‎

• Permit No: M2011007
• IBM Index Class Name: PERMIT FILE
• Doc Date: 1/24/2011
• Doc Name: New 110d Appl.- Ex. F to Ex. U and Rule 8 Emergency Response Plan.
• From: Venture Resources
• To: DRMS
• Media Type: D
• Archive: No

GENERAL PERMIT APPLICATION
STORMWATER DISCHARGES
ASSOCIATED WITH
METAL MINING (Permit No. COR-040000) (and
some Coal Mining - see Instructions)
For Agency Use Only C O R- 0 4
Date Received: / / - -
MIQh n.y Year
ALL APPLICANTS MUST FOLLOW THE DIRECTIONS FOR COMPLETION OF THIS FORM IN
PART C OF THE INSTRUCTIONS
Please print or type. All items must be completed accurately and in their entirety or the application will be deemed incomplete
and the application returned. Processing of the application will not begin until all information is received. Please refer to the
instructions for information about the required items. Original signatures for Items 7 and S are required.
1. Name and address of the permit a?pplli-cant: i? f? 1
Company Name I / V C .
Mailing Address ro 6 OX / 7 X
City, State and Zip Code
2.
3.
4.
Phone Number EF©,3 61 -- 3.2-S
CO
Who is applying? Owner Ope
lE? y ' 1G??? ??
Local Contact (familiar with facility)
Title Phone Number (P3) +0Y-4 31
Local Contact E-mail Address 4?1269E 7777,
Legally Responsible Person (application signer) E-mail Address 4 "a)
11
Location of the Facility:
Street Address
City, State, and Zip Code 9q'5 &T4& 6abcf
County t?1//1J Name of Facility

Latitude/Longitude -- use one of the following formats:

Latitude Longitude (e.g., 39°42'11", 104°55'57")
degrees minutes seconds degrees mmutes seconds
-or-
Latitude Longitude _ ____ _ _ _ _ (e.g., 39.703°, 104.933°f)
degrees (to 3 decimal piaccs) degrees (to 3 decimal places)
Standard Industrial Classification (SIC) Code(s) for this facility. (Include up to three, in order of importance.)
a) ?/0 7Lj// b) c)
Permit Category: Under which mining category does this facility belong? (See Appendix A.)
,?!etal Mining Coal
Mine Category: Which category is your facility under?
Active mine, less than 10 acres Active mine, 10 acres or more Inactive mine
Colorado Division of Reclamation, Mining and Safety Permit Number (if applicable):
Gtacff 1/f 5ZN
3/07/MM i of 2