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Permit Name ' a) CO Div. of Minerals & Geology (formerly MLRD)* Yes X No Date Applied For See cover letter Permit No. b) Dredge or fill permit under Section 404 of the Clean Water Act (CWA) (Army Corps of Engineers) X See cover letter c) CDPS Stormwater ** X See cover letter COR- d) Other - (list) X See cover letter • 14. Other Environmental Permits: Does this facility currently have any other environmental permits, or is it subject to regulation, under any of the following programs? * If Yes to item 14.a), please include Mined Land Reclamation Board permit anniversary date: See cover letter ** If Yes OR No to item 14.c), please read and comply with items 37 and 38, as applicable. 15. Site - specific Conditions: a) Is this operation located within one mile of a landfill, or any mine or mill tailings from a historic site? Yes, see cover letter. b) Is there actual or suspected groundwater contamination such as plumes from leaking underground storage tanks, etc.? No If Yes for any of these, please show location of the landfill, tailings or groundwater contamination on the location map in item 11 or in the site sketch in item 12. Please explain the location, extent of contamination and possible effect on the discharges from this facility. 16. Chemical Treatment: Will any flocculants /settling agents or other chemical additives be used to treat water or otherwise be in the discharge? Noneplanned. If Yes, list here and include the Material Safety Data Sheet (MSDS) with the application if not previously submitted. MSDS should include aquatic toxicity data. Use additional sheets if necessary. Chemical Name * Manufacturer Purpose In Which Waste Stream? If the chemical formula is unknown or confidential, provide the manufacturer's name, contact person, address and phone number or a copy of the manufacturer's brochure, product label information or materials handling data sheet for each product used. Please list the major constituents or active ingredient(s), if known. 17. Used or Manufactured Toxics: The applicant must provide a list of any toxic products which the applicant currently uses or manufactures as an intermediate or final product or byproduct. None 18. Flow Measurement: What method of flow measurement will be used for each discharge point (e.g., v notch weir, pump capacity, parshall flume, etc.)? Designate whether currently installed or proposed. Identify the minimum and maximum flow measurement capability. List the last date calibrated. See cover letter 19. Improvements: Please provide a description of any abatement requirement, abatement project and projected final compliance dates if subject to any present requirements or compliance schedules for construction, upgrading or operation of waste treatment equipment. List any changes from previous permit. None. 20. Land Application: Is or will land application of any wastewater be practiced? No If Yes, please provide a copy of the material submitted to the Colorado Division of Minerals and Geology on the discharge and include a copy of the CDMG approval where applicable. Briefly describe the process: 7