PERMFILE107580

• Permit No: M1994096
• IBM Index Class Name: Permit File
• Doc Date: 11/14/1994
• Doc Name: Stormwater Permit Application
• Media Type: D
• Archive: No

~~ 11: L5i 199+ 15:25 ael~---,3_-~J3°V~
~.
STO ATER DISCHAR()FS
ASS IATED WITH
SAND GRAVEL PRODUCTION
OPERA ONS (AND O'1$IIt
NO ALLIC 11dINFlt~~
E7CC FUEL)
(Permit N .COO-300000)
~~~ IIIIIIIIII
999
IIII III ~ rrauG J9
FOR AdHNCY USH ONLY
Cetrifu:ation Number
C O G - S O
Date Reeaivad Fee Cate o
Ysat Month Day
Please pr4nt or type. Do not metapt to complete this form before reading the imtructioas.
1. Is thls~ the correct appl[dtioa for your fadtlty?? This appllcatioa is ody for the d'ucharge of stormwater.
Do yo~t dlschuge say of the following process generated wsstnwate:a from your facility4
111'0 ^ Yea Product wash waters
~~ppjj. 11+0 ^ Yea Maintaoance/equlpment wash waters
~1 I~fo ^ Yea T'ranapott waters (o.g., slurries)
o ^ Yea Scrubber watua (crwhea or classifiara)
o ^ Yoe Mlae dewttteriag (~ouadwater and/or runoff from the mine)
if you answered yg to any of those queationa, do not complete titia application. You mwt instead complete the
Proot:}s Water and Stormwater Dlecltargas Asaodated with Sand and Gra.el application for thla facility, which is
available from the Division.
2.
3.
7f91/,a
sad address of pamlt applltxutt:
Name:
al `taxpayer (or Employer)1D~: ~ ~ 3 " ~ ~ _ ~ ~ 2 Svc ; a / S ~ ~ ~'`
tg Addreu: J .~ ~ U U ~) . C c. Q S -~i
State and Zip Code: r"i L ~ t , ` " . ~0 " P ~ ~ ~ ~ a
i Number (?y3, :, (v S
Contact (familiu with facility):
of the fadllty:
Address:
Phone Number: ( )

Staze and Zlp Code:
.y: L 4 r .' .-vt ~,r Name of facility:
Location (Township, Range, section, 114 section):
tde and Longitude: ~{ n ° y .~ m % ~ /, s sec.
of FacWty: ^ New (beginning operadoro after 10/1/92)
-1-
- ~,5 S / plho is applying for the permit'! lL`y Owner U Operator
e
Existing (sa of 10/I/92)
H
e