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INSTRUCTIONS FOR THE COMPLETION OF THE FORM <br />APPLICATION FOR EMISSION PERMIT <br />COLORADO AIR POLLUTION CONTROL DIVISION <br />The following instructions for the completion or" the Application for Emission Permit <br />•,a re titled, lettered, and numbered the same as the applicable sections of the form <br />on the other side. <br />i. PERMIT ISSUED T0. list the name of the person (e.g., corporation, partnership, <br />association, individual owner, or government agency) to whom the license is to <br />be issued and who will therefore be responsible for the operation of the source. <br />2. MAILING ADDRESS. <br />3. TYPE OF ORGANIZATION. Corporation, partnership, association, individual, <br />government agency, etc. <br />4. AGENT OF SERVICE. Person or persons designated to accept service of process. <br />5. GENERAL NATURE OF BUSINESS. List the business activity; for example, meat packer, <br />saw mill, furniture manufacturer, commercial printing, ti re retreading, etc. Also <br />list type of business activity per Standard Industrial Classification (S.I.C.). <br />6. AIR POLLUTION SOURCE. List common name of: <br />a. Emission Source: This class includes any building, facility, structure, <br />installation, activity, machine, equipment or device, the use of which <br />may cause the emission of air pollutants. <br />• b. Air Pollution Control Equipment: This class includes any article, machine, <br />equipment or contrivance, the use of which may eliminate, reduce, or control <br />the emission of air pollutants. <br />7. SOURCE ADDRESS: If the source is portable, list the locations and dates where <br />source will be operated during duration of permit period. Please include a <br />map indicating the exact location and showing mayor topographic features. <br />8. ESTIMATED COST OF SOURCE OR MODIFICATIONS. Enter estimated cost of Air Pollution <br />Control Equipment and Emission Source as described under 6 above. <br />9. STATUS. Check one box applicable to status of source. Two dates required. <br />10. APPLICATION FEE. Pay only $40.00 filing fee at this time. Initial and final <br />approval fees shall be requested by separate letter. <br />11, ANTICIPATED STARTING DATE. This estimated date allows the Division to conduct <br />the required emissions inventory. <br />12. DATE OF APPLICATION. <br />13. SIGNATURE OF LEGALLY AUTHORIZED PERSON. The form must be signed by a person <br />legally responsible far his action as agent of the person listed in Item 1. <br />i4. THIS APPLICATION MUST BE SIGNED BY THE INDIVIDUAL(S) RESPONSIBLE FOR AND AUTHORIZED <br />TO ACT ON BEHALF OF THE APPLICANT. <br />• 5. REMARKS. Applicant may request a copy of the preliminary engineering analysis <br />in this space. <br />