2017-06-02_PERMIT FILE - M2016085

• Permit No: M2016085
• IBM Index Class Name: Permit File
• Doc Date: 6/2/2017
• Doc Name: Addendum To Application
• From: Northern Colorado Constructors
• To: DRMS
• Email Name: PSH
• Email Name: WHE
• Media Type: D
• Archive: No

Permit Number:
AIRS ID Number:
Section 5 - Applicant Certification
I hereby certify that all information contained herein and information submitted with this application is complete, true
and correct.
Signature of Legally A�horized Person (not a vendor or consultant)
Chris Zadei
Name (please print}
Check the appropriate box to request a copy of the,
❑ Engineer's Preliminary Analysis conducted
❑ Draft -permit prior to issuance
❑ Draft permit prior to public notice
Treasurer
(Checking any of these boxes may result in an increased fee and/or processing time)
5117117
Date
T;tle
This emission notice Is valid for five (5) years. Submission of a revised APEN is required 30 days prior to expiration
of the five-year term, ar when a reportable change is made (significant emissions increase, increase production,
new equipment, change in fuel type, etc). See Regulation No. 3, Part A, il.C, for revised APEN requirements.
Send this form along with $152.90 to:
Colorado Department of Public Health and
Environment
Air Pollution Control Division
APCD-SS-B 1
4300 Cherry Creek Drive South
Denver, CO 80246-1530
Telephone: [phone]
For more information or assistance call:
Small Business Assistance Program
[phone] or [phone]
Or visit the APCD website at:
https://www.colorado.govlcdphe/aped