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6. Describe the industrial activities which take place on site. <br /> 7. Other Environmental Permits: Does this facility currently have any environmental permits, or is it subject to <br /> regulation, under any of the following programs? <br /> No Yes Permit# or ID# <br /> a) Colorado Discharge Permit System (CDPS or NPDES) _ _ <br /> b) Resource Conservation and Recovery Act (RCRA) _ _ <br /> ► If Yes, is your facility a Treatment, Storage or Disposal facility? <br /> c) Colorado Division of Minerals and Geology (formerly MLRD) _ _ <br /> d) Superfund Amendments and Reauthorization Act (SARA), Title III <br /> (Emergency Planning and Community Right-to-Know Act), Section 313 _ _ <br /> NOTE: Both Items 8 and 9 must be signed in order for the application to be processed. <br /> 8. Stormwater Management Plan <br /> a) Heavy Industry, Light Industry, Mining: a Stormwater Management Plan (SWMP) shall be prepared prior to <br /> applying for coverage under a general permit, and the following certification signed. See SWMP requirements in <br /> Appendix B (Light and Heavy Industry) or Appendix C (Mining). <br /> "I certify under penalty of law that a complete Stormwater Management Plan (SWMP), in compliance with <br /> Appendix B / C - (circle one) of the application, has been prepared for my facility. The SWMP was prepared <br /> under my direction or supervision and with a system designed to assure that qualified personnel properly gather <br /> and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, <br /> or those persons directly responsible for gathering the information, the SWMP is, to the best of my knowledge <br /> and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false <br /> information, including the possibility of fine and imprisonment." <br /> Signature of Permit Applicant Date Signed <br /> Name (printed) Title <br /> b) Heavy Industry: the permittee shall also submit a copy of the SWMP to the Division with the permit application. <br /> SWMP enclosed? ❑ No ❑ Yes <br /> 9. Signature of Applicant (legally responsible person) <br /> "I certify under penalty of law that I have personally examined and am familiar with the information submitted in <br /> this application and all attachments and that, based on my inquiry of those individuals immediately responsible for <br /> obtaining the information, I believe that the information is true, accurate and complete. I am aware that there are <br /> significant penalties for submitting false information, including the possibility of fine and imprisonment." <br /> Signature of Permit Applicant Date Signed <br /> Name (printed) Title <br /> 7/96/Ihm -2- <br />