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Permit Number: AIRS ID Number: <br /> [Leave blank unless APCD has already assigned a permit u and AIRS ID] <br /> Section 8 - Applicant Certification <br /> I hereby certify that all information contained herein and information submitted with this application is complete, <br /> true, and correct. If this is a registration for coverage under General Permit GP06, I further certify that this source <br /> is and will be operated in full compliance with each condition of General Permit GP06. <br /> gnature Legally Authorized Person (not a vendor or consultant) Date <br /> l_w-a iris yc/• �.10�.�s o•+ we�».,a v �>� <br /> Name(print) Title <br /> Check the appropriate box to request a copy of the: <br /> ❑� Draft permit prior to issuance <br /> ❑� Draft permit prior to public notice <br /> (Checking any of these boxes may result in an increased fee and/or processing time) <br /> This emission notice is valid for five(5)years. Submission of a revised APEN is required 30 days prior to expiration <br /> of the five-year term,or when a reportable change is made (significant emissions increase, increase production, <br /> new equipment, change in fuel type, etc.). See Regulation No. 3, Part A, II.C. for revised APEN requirements. <br /> Send this form along with $191.13 and the General Permit For more information or assistance call: <br /> registration fee of$1,125.00, if applicable, to: <br /> Small Business Assistance Program <br /> Colorado Department of Public Health and Environment (303)692-3175 or(303) 692-3148 <br /> Air Pollution Control Division <br /> APCD-SS-B1 APCD Main Phone Number <br /> 4300 Cherry Creek Drive South (303)692-3150 <br /> Denver, CO 80246-1530 <br /> Make check payable to: Or visit the APCD website at: <br /> Colorado Department of Public Health and Environment https://www.colorado.eov/cdphe/apcd <br /> COLORADO <br /> Form APCD-233 - Compression Ignition Engine APEN - Revision 3/2019 6 I _® <br />