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. .. ........ ._.. ...__ <br /> ':'FOR AGENCY.IISE".OP1I:Y:.: <br /> :..: RMIT NUMER'"::•:.::..,:':;;, :'.:;`:•: .. <br /> COAL NEPiUNG- <br /> PROCESS WATER AND STORMWATER :. . :.: .:... : .... . :•...:::;.::_ <br /> :.DATE RECIIVED..:::: <br /> DISCHARGE APPLICATION <br /> : .:':MONTH'.•. : ::. DAY:: <br /> PLEASE PRINT OR TYPE Do not attempt to complete this form before reading the accompanying instructions. <br /> New ❑ or Renewal ® If renewal,existing permit number: CO —0 0 0 01 C)6 1 0 CT 29 1�13 <br /> 1. Name and Address of Operator: (former operator — see attached, ;item•-,rl )-n,�_. - <br /> - <br /> CompanyName: Mid rnn-hi nPnt RPGnnrres . Tnr- <br /> Federal Taxpayer(or Employer)M#: 3 6—14 5 719 3 <br /> Mailing Address: 1) n P n v 5 n n - <br /> City, State and Zip Code: Carbondale , CO 81623 <br /> * <br /> Phone Number:L9 7 0 ) q 6 3—2 S£i 1 Who is applying for the permit? ❑ Owner � Operator (former ) <br /> Local Contact(familiar with facility): Len Wardlaw Title: N/A <br /> Phone Number: ( 970 963-2681 FaxNo.: (970) 963-2816 <br /> 2. Name and Address of Owner: <br /> Name: See Attached , item "2 <br /> Mailing Address: <br /> City, State and Zip Code: <br /> Phone Number: ( 1 Fax No.: ( ) <br /> 3. Location of the Facility: <br /> Street Address: 4 , 5 miles w�s t o f R P ci G t n n P , r n <br /> City, State and Zip Code: N/A <br /> County: P i t-k i ri Name of facility : 'Er)r m P r In i n P c� t P r`02 b R a c i n <br /> Legal Location(Township. Range, section, 1/4 section): ..See a t t a e h e d.— ----- <br /> Latitude and Longitude_ c e e ; , <br /> 4. Corporate Structure: Please provide, on a separate sheet, the corporate szrucrure(s) for those companies listed in items 1 and 2. The <br /> structure should extend to the ultimate parent company. In the case of a joint venture, please provide this information for each company <br /> which is pan of the joint venture, as well as ownership interests. <br /> 5. Standard Industrial Classification (SIC) Code(s) for this facility. (Include up to four, in order of importance.) <br /> a) 12 * b) c) d) <br /> *Mining ceased in 1991 . <br />