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APPLICATION for DISCHARGES ASSOCIATED WITH SAND & GRAVEL MINING AND PROCESSING <br />13. WATER QUALITY DATA <br />Analytical data for the following parameters shall be submitted for at least one grab sample from each discharge point. If n o water is <br />currently available for analysis, so indicate. <br />Alkalinity (mg/1) <br />Dissolved Solids (mg/I)Total <br />Suspended Solids (mg/1) <br />Oil and Grease (mg/1) <br />no water to analyze <br />The Division may request analysis of other parameters once the application has been reviewed. <br />14. ACTIVITY DURATION <br />When did the activity commence? late spring 2011 <br />pH (s.u.) <br />COD (mg/1) <br />No water to analyze at this time <br />What is the estimated life of the activity from which the discharge(s) identified i n Section 4 originate? 10 years. <br />15. REQUIRED SIGNATURES (Both parts 1. and fl. must be signed) <br />STOP!. A Stormwater Management Plan must be completed prior to signing the following certifications! <br />This item applies to all facilities. A Stormwater Management Plan (SWMP) shall be prepared prior to applying for coverage under the <br />general permit, and the following certification signed. See the SWMP requirements in Appendix B. <br />I. Stormwater Management Plan Certification <br />"I certify under penalty of law that a complete Stormwater Management Plan, as described in Appendix B of this application, has been <br />prepared for my activity. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for <br />gathering the information, the Stormwater Management Plan is, to the best of my knowledge and belief, true, accurate, and complete. I am <br />aware that there are significant penalties for falsely certifying the completion of said SWMP, including the possibility of fine and <br />imprisonment for knowing violations." <br />Signature of Legally Responsible Person (submission must include original ink signature) Date Signed <br />Name (printed) <br />ii. Signature of Permit Legal Contact <br />Title <br />"I certify under penalty of law that I have personally examined and am familiar with the information submitted in this application and all <br />attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the <br />information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the <br />possibility of fine or imprisonment. <br />"I understand that submittal of this application is for coverage under the State of Colorado General Permit for Stormwater Discharges <br />Associated with Construction Activity for the entirety of the construction site/project described and applied for, until such time as <br />the application is amended or the certification is transferred, inactivated, or expired." <br />Signature of Legally Responsible Person (submission must include original ink signature) <br />Date Signed <br />Name (printed Title <br />DO NOT INCLUDE A COPY OF THE STORMWATER MANAGEMENT PLAN <br />DO NOT INCLUDE PAYMENT - AN INVOICE WILL BE SENT AFTER THE CERTIFICATION IS ISSUED. <br />Page 5 of 5 Revised 12/2009