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Please print or type. Do not attempt to complete this form before reading the instructions. <br />PROCESS WATER AND STORMWATER <br />DISCHARGES ASSOCIATED WITH <br />SAND AND GRAVEL PRODUCTION <br />OPERATIONS (AND OTHER <br />NONMETALLIC MINERALS <br />EXCEPT FUEL) <br />New or Renewal XX If renewal, existing permit number: CO_ 0500425 <br />1. Name and address of permit applicant: <br />Company Name: Ready Mixed Concrete Company dba Ready Mixed Aggregates, Inc. <br />Federal Taxpayer (or Employer) ID #: 84- 0360534 <br />Mailing Address: 14585 Old Brighton Road <br />City, State and Zip Code: Brighton, CO 80601 <br />Phone Number: (303) 659 -0630 <br />Local Contact (familiar with facility): Mr. Nathan Merkison <br />Phone Number: (303) 659 -0630 <br />Who is applying for the permit? XX Owner XX Operator <br />Name and address of property owner: <br />Name: Ready Mixed Concrete Company <br />Mailing Address: 4395 Washington Street <br />City, State and Zip Code: Denver, CO 80216 <br />Title: Plant Manager <br />Fax No.: (303) 659 -7353 <br />TYPE: <br />Phone Number: (303) 292 -1771 Fax No.: (303) 295 -0470 <br />Legal Location (Township, Range, section, 1/4 section): T3N: R67W: S32 (parts of NE. SE. and SW 1 /4's) <br />Latitude and Longitude: 040 °, 11', 50" N; 104 °. 53', 34" W <br />FOR AGENCY USE ONLY <br />PERMIT NUMBER <br />C <br />0 <br />DATE RECEIVED <br />YEAR <br />MONTH <br />DAY <br />P <br />S <br />3 Location of the facility: <br />Street Address: North of Weld County Road (WCR) 28. west of WCR 19. and south State Highway 66, just east of Saint Vrain Creek. <br />approximately in the village of Gowanda Colorado <br />City, State and Zip Code: Mead. CO 80542 <br />County: Weld Name of facility: Nix Quarry <br />1 171 0)-00 - o 1,4 <br />