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• • III IIIIIIIIIIIII III <br />CONSTRUCTION AGGREGATE <br />11.'DUSTRIAL 'dASTEl7ATER DISCHARGE APPLICATION <br />FOR ACENCI' USE <br />APPLICATION NUMBER <br />DATE RECEIVED <br />/ / <br />YEAR MONTH DAY <br />Do not attempt to complete this form before reading the accompanying instructions. <br />PLEASE PRINT OR TYPE <br />NEW X OR RENEWAL (existing permit No. ) <br />1. Name, address, and telephone number of the owner of the facility producing <br />discharge. ,.l (~^~ <br />Property owner(s) Wes'/;~;L/ ~ J2//iG JCJ~ <br />Telephone Number 0002) rZQQ~Z~// <br />Mailing Address <br />Street Address 7`/3U ,LcL /4/U/Yia- Ui': <br />City TuCS ~/! _ State__ OA r iz . <br />County PrMLI.- Zip Code// a s7/ <br />Name of operation C'4 ~7 c/u/7 SQncl' ~ Vat/C.~ <br />Local contact(familiar with process) ~o bt.r f SGO >~ <br />Telephone Number (3J3) 73/"'I'Z~9 <br />2. Is the facility operated other than by the owner?YES NO <br />I° YES, complete the fo99llowing: <br />Operator /~O G G r 7 <br />Mailing Address //~~~ G ~QX 3(02 v <br />Street/%Addres.ti /A~y~a SF~r~n•ryJ ) / <br />City i"0. C~OSct .S~J///!q3 State ~o(J r0..G7y <br />/~ <br />County /~/~/7 /~GTC`/n,7 Zip Code ///~s'7 <br />Name of Operation (~~tn~y~l rJG2-/1(,~ ~ C7~0.V2-~ <br />Local Contact <br />Telephone tJumber <br /> <br />Also, on the back side of this page describe the relationship, <br />agreements and time frame of any agreement. <br />