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Permit Number: AIRS ID Number: <br /> [Leave blank Unless APCD has already assigned a permit r,and AIRS ID) <br /> Section 2 - Requested Action <br /> ❑� NEW permit OR newly-reported emission source(check one below) <br /> ❑✓ STATIONARY source ❑ PORTABLE source3 <br /> -OR- <br /> ❑ MODIFICATION to existing permit(check each box below that applies) <br /> ❑ Change equipment ❑ Change status: ❑ Add point to existing <br /> portable/stationary permit <br /> ❑ Change processing limit ❑ Transfer of ownership' ❑ Change company name' <br /> ❑ Other(describe below) <br /> -OR- <br /> ❑ APEN submittal for update only(Blank APENs will not be accepted) <br /> -ADDITIONAL PERMIT ACTIONS- <br /> ❑ APEN submittal for permit-exempt/grandfathered source <br /> ❑ Voluntary permit for otherwise permit-exempt source' <br /> Additional Info ix Notes: <br /> 3 Note that a permit-exempt portable source may be required to obtain a permit based on the facility-wide emissions totals of <br /> the operating location. <br /> 4 For transfer of ownership,a completed Transfer of Ownership Certification Form(Form APCD•104)must be submitted. <br /> 'For company name change.a completed Company Name Change Certification Form (Form APCD-106)must be submitted. <br /> Section 3 - General Information <br /> F/1 Crusher Only ❑ Screen Only ❑ Crusher-Screen Combo Unit <br /> If"Crusher-Screen Combo Unit"is selected,the crusher and screen must be bolted together and must always travel as one unit. if <br /> this is not true,you must fill out a separate APEN for each piece of equipment. <br /> Manufacturer: TBD Model No.: TBD Serial No.: TBD <br /> Company equipment Identification No. (optional): Feeder Breaker <br /> For existing sources, operation began on: NA <br /> For new or reconstructed sources, the projected start-up date is: TBD <br /> ❑Check this box if operating hours are 8,760 hours per year; if fewer, fill out the fields below: <br /> Normal Hours of Source 24 hours/day 5 days/week 52 weeks/year <br /> Operation: _ <br /> Seasonal use Dec- Mar- June- Sept- <br /> percentage: Feb: 100 % May: 100 % Aug: 100% Nov: 100 % <br /> How many material transfer points are included on this equipment? 2 <br /> A transfer point is defined as any location where material moves from a conveyor to another conveyor,screen,or pile. It <br /> does not include the transfer of material into a hopper. <br /> carom>oo <br />