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:; FOR- <br /> PERMIT NUMBER::: <br /> COAL MINING <br /> PROCESS WATER AND STORMWATER : :.....; <br /> DISCHARGE APPLICATION <br /> '•YEAR:';;%:�� :` �MOI+FTH; <>, ; �<Y<.<.::::>::I7i43C �:::'::�r., <br /> PLEASE PRINT OR TYPE Do not attempt to complete this form before reading the accomp ctions. <br /> New ❑ or Renewal ® If renewal,existing permit number. CO G-850026 <br /> 1. Name and Address of Operator: <br /> Company Name: Mid—Continent Resources, Inc. <br /> Federal Taxpayer(or Employer)ID#: 36-1475193— e <br /> Mailing Address: P.O. Box 500 <br /> City, State and Zip Code: Carbondale, CO_ 81623 <br /> Phone Number: ( 970) 963-2581 Who is applying for the permit? 0 Owner ❑ Operator <br /> Local Contact(familiar with facility): Len Wardlaw Tide: EnPloyee <br /> Phone Number. ( 97q 963-2581 Fax No.: ( 970Q 963-2816 <br /> 2. Name and Address of Owner: <br /> Name: Mid—Continent Resources, Inc. <br /> Mailing Address: P.O. Box 500 <br /> City, State and Zip Code: Carbondale, CO 81623 <br /> Phone Number. ( 970) 963-2581 Fax No.: (970 ) 963-2816 <br /> 3. Location of the Facility: <br /> Street Address: 1058 County Rdad 100 <br /> City, State and Zip Code: Carbondale, CO 81623 <br /> County: Garfield Name of facility : of <br /> Legal Location(Township, Range, section, 1/4 section): SE 1/4, Section 35, VS, R88W, 1 mile east CarbondalE <br /> Latitude and Longitude• <br /> 4. Corporate Structure: Please provide,on a separate sheet, the corporate structure(s)for those companies fisted 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 part 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) 4225 b) 0 d) <br /> 7 <br /> Coal Mining App.4196 l <br />