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Permit Name <br />Yes <br />No <br />Applied For, Date <br />Permit No. <br />a.) Colorado Division of Minerals and Geology <br />(formerly MLRD) <br />Permit Anniversary Date <br />X <br />■ <br />Issued date: <br />9/7/1983 <br />M 1983 -141 <br />b.) Underground Injection Control <br />U <br />U <br />c.) Dredge or fill permit under Section 404 of the Clean <br />Water Act (CWA) (Army Corps of Engineers) <br />❑ <br />d.) Resource Conservation and Recovery Act (RCRA) <br />❑ <br />❑ <br />e.) CDPS Stormwater <br />(If YES, please include copy of <br />site's Stormwater Management Plan) <br />X <br />❑ <br />f.) Colorado State Air Pollution Emission <br />❑ <br />❑ <br />g.) Other <br />❑ <br />APPLICATION for DISCHARGES ASSOCIATED WITH HARDROCK MINING AND /OR MILLING <br />12. OTHER ENVIRONMENTAL PERMITS <br />Does this facility currently have any environmental permits, or is it subject to regulation, under either of the following programs? <br />I de-specific conditions: II Is this operation located within one mile of a landfill, or any mine or mill tailings? ❑ NO YES <br />b) Does the dewatering area have or possibly have groundwater contamination, such as <br />plumes from leaking underground storage tanks, etc.? U NO ❑ YES <br />If YES for any of these, please show location of the landfill, tailings or possible groundwater contamination on the location map in <br />item 9 or in the site map sketch in item 10. Please explain the location, extent of contamination, and possible effect on the <br />discharges from this facility. <br />The mill tailings pond is located up gradient from the Cash Mine; no groundwater contamination. <br />14. Bath House /Dry and Sanitary Waste: Is there a bath house /dry at this facility? II NO U YES <br />Are there sanitary wastewater facilities or sanitary treatment systems at this facility? I NO ❑ YES <br />If YES, what is the disposition of any wastewater generated? <br />15. Chemical tr t: Will any flocculants (settling agents or chemical additives) be used to treat water prior to discharge? <br />YES If YES, list in the following table, and include the Material Safety Data Sheet (MSDS): <br />If the chemical formula is unknown or confidential, provide the manufacturer's name, contact person, address and phone number <br />or a copy of the manufacturer's brochure, product label information or materials handling data sheet for each product used. <br />Please list the major constituents or active ingredient(s), if known. <br />Revised 4/2011 <br />