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QrQ4i3/7- /Yi- (? <br />Water Quality Control Division - Stormwater www.coloradowaterpermits.com <br />B. Permitted Project/Facility Information <br />Project/Facility Name JUBILEE VENTURE LLC <br />Street Address or cross streets COUNTY ROAD 17 & 102 <br />City, Zip Code County MOFFAT <br />Facility Latitude/Longitude- (approximate center of site to nearest 15 seconds using one of following formats <br />001A Latitude Longitude (e.g., 39.703°, 104.933°') <br />degrees (to 3 decimal places) degrees (to 3 decimal places) <br />/ or <br />001A Latitude Longitude107 ° 7 ' L4 " (e.g., 39°46'11"N, 104°53'11"W) <br />degrees minutes seconds degrees minutes seconds <br />C. STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE(S) FOR THIS FACILITY <br />(See Appendix A - include up to 4 in order of importance). <br />a 1041 <br />b 1044 <br />C. <br />D DESCRIBE THE INDUSTRIAL ACTIVITIES WHICH TAKE PLACE ON THIS SITE <br />d. <br />Describe the primary industrial activities at this facility (e.g., trucking firm with vehicle maintenance; computer equipment manufacturer; <br />automobile or scrap metal recycling; precious metal mining, milling, metal mining services; coal mine etc.). Indicate whether or not the <br />facility has a coal pile. If this application is for any of the following types of facilities, also provide the additional information indicated: <br />Airport: state the estimated volume of deicers used, and the volume of fuel sold, on an annual basis. <br />Wastewater treatment plant: include the design flow and pretreatment program status. <br />Steam electric power plant: indicate the primary and backup fuel sources. <br />Paving and roofing materials manufacturing: indicate whether or not the facility manufactures asphalt emulsion. <br />Asphalt or concrete batch plant: indicate whether or not the plant is portable. <br />Description: <br />Precious metal placer mining. See attached Exhibit D Eagle Mine project and Exhibit E. <br />E. RECEIVING WATERS <br />Identify the receiving water of the stormwater from the industrial facility. Receiving waters are any waters of the State of Colorado including <br />all water courses, even if they are usually dry. If stormwater from the facility enters a ditch or storm sewer system, identify that system and <br />indicate the ultimate receiving water for the ditch or storm sewer. Note: a stormwater discharge permit does not allow a discharge into a <br />ditch or storm sewer system without the approval of the owner/operator of that system. <br />Immediate Receiving Water(s): <br />Ultimate Receiving Water(s): <br />Page 3 of 8 <br />Ground Water <br />West Timber Lake Creek <br />'fig 'c -i& <br />Revised 3/2011