_PERMIT FILE - M2013026

• Permit No: M2013026
• IBM Index Class Name: Permit File
• Doc Name: Other Applications
• Media Type: D
• Archive: No

STATE OF COLOWO For Agency Use Only
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Dedicated to protecting and Improving the health and environment of the people of Colorado
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4300 Cherry Creek Dr.S. Date Received
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Denver,Colorado 80246.1530 re�c Month Day Year
Phone[phone] REGULATION
MD Line(303)691.7700 Colorado Depament
Located in Glendale,Colorado
oFlhibl'a Health WATER BODY ID
http:/Avww.cdpha.stata.co.us andEnvironment
APPLICATION for STORMWATER DISCHARGES ASSOCIATED WITH:
• HEAVY and LIGHT INDUSTRIAL ACTIVITY
• METAL MINING (and some Coal Mining)
• RECYCLING INDUSTRY
Please print or type. Original signatures are required. FAXED COPIES OR PDF COPIES WILL NOT BE ACCEPTED.
This application is for use by all industrial stormwater dischargers engaged in heavy and light industrial activity, metal
mining (and some coal mining), and the recycling industry as categorized by Standard Industrial Classification Code(SIC
code) (see Appendix A.)
The application must be submitted to the Water Quality Control Division (the Division) at least 30 days prior to the anticipated
date of discharge, and must be considered complete by the Division before it will begin the review and approval process. The
Division will notify the applicant if additional information is needed to complete the application. If more space is required to
answer any question, please attach additional sheets to the application form. Applications must be mailed or delivered to:
Colorado Department of Public Health and Environment
Water Quality Control Division
4300 Cherry Creek Drive South
WQCD-P-B2
Denver, Colorado 80246-1530
PERMIT TYPE
Indicate the stormwater discharge permit type this application applies to. Refer to Appendix A for appropriate permit type based on the
primary industrial activity conducted at the facility. Note:Applications for Heavy Industrial Activity and the Recycling Industry stormwater
discharge permit types must include a copy of the Stormwater Management Plan.
❑ Heavy Industrial Activity (A copy of the Stormwater Management Plan must be submitted to the Division with the application.)
❑ Light Industrial Activity
❑ Metal Mining El Inactive mine El active over 10 acres ❑ active under 10 acres
❑ Recycling Industry (A copy of the Stormwater Management Plan must be submitted to the Division with the application.)
APPLICANT
The applicant must be a legal entity that meets the definition of either the owner and/or operator of the industrial activities that occur at the
facility for this application to legally cover the industrial activities. The applicant must have day-to-day supervision and control over
activities at the facility and implementation of the Stormwater Management Plan(SWMP).
Alternative Permittees:Other agents may also obtain permit coverage if they have clear contractual responsibility and operational control
to address the impacts industrial activities may have on stormwater quality(including SWMP implementation). Examples include
consultants or property owners acting as facility managers under contract with the owner or operator of the industrial activities, as long as
the contractual relationship clearly delegates responsibility for stormwater management.A property owner that is not associated with the
actual industrial activities at the site or under contract to adequately perform the stormwater management responsibilities at the site,as
discussed above, may not legally maintain permit coverage for industrial activities at their property.
Applicant is: ❑ Property Owner ❑ Contractor/Operator
Page 1 of 8 Revised 3/2011