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FOR AGENCY USE ONLY ' <br /> PER'4IIT lr'UNOER _ <br /> i <br /> COAL 'N=' G- IIC ( Of I I I I I I I I <br /> PROCESS WATER AND STOR.Nn ATER <br /> DISCHARGE APPLICATION DATA.RECM-ED <br /> I ( <br /> Y=AR MONTri I DAY <br /> PLEASE PRINT OR iYPE Do not attempt to complete this form before reading the accompanying instructions. - <br /> New ❑ or Renewal ® If renewal, existing permit number: CO —n n n n <br /> ?. Name and Address of Operator: ( former operator — see attached, item t1 <br /> Company Name: yj Cl—rnn+ i rpr,� Tnf _ <br /> Fede al Taxpayer(or Employer) ID#: 3 6—1 G 5 71 9 3 _ _ <br /> Mailing Address: p n n <br /> City, Star- and Zip Code: Carbondale , CO 81623 <br /> Phone Number. (9 7 0 ) q 6 3—2 5 8 1 - Who is applying for the permit? Owner Operator (former ) * <br /> Local Contact(farular with facility): Len W a r d l a w Title: N/A <br /> Phone Nu-ber ' c 7 C 9 6 — P 1 Fax No.: ra 7 01 9 6 3—2 816 <br /> :. Name and Address of Owner: <br /> m <br /> Name: See attached item <br /> Mailing Address: <br /> Cie. SaL' aad Code. <br /> Phone Nutnber: 1 Fax No.: ( ) - <br /> S. Location of the Facility: <br /> SC=E Address: rri ' oC ti G ^_ T.)n'�c�'- a <br /> City. State and Z:p Code: L <br /> �, f —.1.^mp <br /> r.Ot:t1I': �" Name 0 far:li- <br /> Legal L.&=::cn Range, sccucn, l iY sec-lon;: See attache`-_ s <br /> Lana:de a..d Longimde_ <br /> CO:JOr::e S�uc^�-^-: ?le=se provide, on a separ= sttt,, the s•:.:c:sre;s) for t"�ose companies listed in ite::ts 1 and 2. The <br /> sc'-z _ <br /> snouid _.. nd : .:.a <br /> t^ <br /> o :he u1r. te uaren: c . a.•ly. . . ne c.,_-e of a join: venture please provide this informauor. for each company <br /> �a <br /> whi is par- of tel;otrr venture, as well as ownersnip interests. <br /> 5. Standard Industrial Classificuion (SIC) Code(s) for tl:s f,ciiiry. (Include up to four, is order of importance.) <br /> a) 1 -) * b) c) d) <br /> *mininc ceased in 1991 . <br />