Laserfiche WebLink
Colorado Department of Public Health&Environment FOR AGENCY USE ONLY <br /> Water Quality Control Division <br /> WQCD-P-B2 REC <br /> 4300 Cherry Creek Drive South EFF <br /> Denver, Colorado 80246-1530 YEAR MONTH DAY <br /> INACTIVATION NOTICE FOR <br /> MINING STORMWATER DISCHARGE GENERAL PERMIT CERTIFICATION <br /> Please print or type. Form m completely. <br /> Certification Number: COR-04 O - D Q Taxpayer ID or EIN 4 ¢ y <br /> --OR-- COG-50 <br /> Permittee(Company)Name: C v(v R o S t6o.✓ A.c /t - ld G g <br /> Permittee Address: /.3 1 3 ,S/�/L/�`74A., S 7-fl t e T /l 0-1et— <br /> � e.v✓c/..- C 1-7-c( YvLo3 <br /> Mine/Facility Name: C v,t! Po Ad. t C C 4-,n/-)"-1 a--- <br /> Mining Site Address/Location: C'A-4d o C r.A t C/I K /1 v'4 aL 4 r'+• i•s <br /> yr Rt.d.5 A-e /2.CCt 5ra-t C&-/0/2.4-a0 <br /> County: /�, r f'c. ti Contact Person: S Tt +. e- .v 12e 0v n�e/L <br /> Reason/justification for inactivation, and description of final site stabilization. (Attach any supporting documentation, such <br /> as proof of Mined Land Reclamation Board bond release): <br /> I certify under penalty of law that by the date of my signature below,all disturbed soils at the identified mining site have <br /> been finally stabilized;all temporary erosion and sediment control measures have been removed; all mining and equipment <br /> maintenance waste have been disposed of properly; and all elements of the Stormwater Management Plan have been <br /> completed. <br /> I understand that by submitting this notice of inactivation,I am no longer authorized to discharge stormwater associated <br /> with mining activity by the general permit. I understand that discharging pollutants in stormwater associated with mining <br /> activities to the waters of the State of Colorado, where such discharges are not authorized by a CDPS permit,is unlawful <br /> under the Colorado Water Quality Control Act and the Clean Water Act. <br /> I certify under penalty of law that I have personally examined and am familiar with the information submitted herein, and <br /> based on my inquiry of those individuals immediately responsible for obtaining the information,I believe that the information <br /> is true,accurate and complete. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of fine and imprisonment. (See 18 U.S.0 1001 and 33 U.S.C. 1319.) <br /> Ll <br /> Signature of Permit Applicant(Legally Responsible Party) Date Signed <br /> 9/97/ u e prinle itle <br />