2013-01-25_INSPECTION - M1983141

• Permit No: M1983141
• IBM Index Class Name: INSPECTION
• Doc Date: 1/25/2013
• Doc Name: DISCHARGE PERMIT APPLICATION
• From: GOLD HILL MINES
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

APPLICATION for DISCHARGES ASSOCIATED WITH HARDROCK MINING AND /OR MILLING
5) BILLING CONTACT if different than the permittee
Latitude:
OR
Latitude:
Responsible Position (Title):
Currently Held By (Person):
Telephone No:
email address
6) OTHER CONTACT TYPES (check below)
Responsible Position (Title):
Currently Held By (Person):
Telephone No:
email address
Organization:
Mailing Address:
City:
fl Pretreatment Coordinator
• Environmental Contact
❑ Biosolids Responsible Party
2. PERMITTED FACILITY INFORMATION
Name of Plan, Project or Development: Cash Mine
Location of construction site:
Street Address (or cross streets):
City (if unincorporated, so indicate): County:
State and Zip Code:
Latitude and Longitude (approximate center of site to nearest 15 seconds using one of following formats):
Legal Location — Township, Range, Section, '/A Section
Township 1 North, Range 72 West, Section 12, SE 1/4
6th P.M.
3 STANDARD INDUSTRIAL CLASSIFICATION (SIC) CODE(S) FOR THIS FACILITY (Include up to 4 in order of importance.
1. 1041
Organization:
Mailing Address:
City: State: Zip:
40° 03' 38.60577
degrees /minutes/ seconds
degrees (to 3 decimal places)
2. 5082
Add pages if necessary:
State: Zip:
▪ Property Owner
La Inspection Facility Contact
❑ Consultant
Longitude:
Longitude:
105° 23' 57.54869
degrees/ minutes/ seconds
degrees (to 3 decimal places)
3.
▪ Compliance Contact
Stormwater Authorized
Representative
▪ Other
(e.g., 39 °42'11 ", 104 °55'57 ")
(e.g., 39.703 °, 104.933')
4.
Revised 4/2011