PERMFILE48813

• Permit No: C1983058
• IBM Index Class Name: Permit File
• Doc Date: 12/11/2001
• Section_Exhibit Name: APPENDIX C - Other Permits
• Media Type: D
• Archive: No

AIR POLLUTION CONTROL DIVISION - COLORADO DEPARTMENT OF HEALTH
4210 E. 11th Avenue, Denver, Colorado 80220 - Phone: [phone]
APPLICATION FOR EMISSION PERMIT
This application shall be filled out comoTeteTy - see instructions on reverse side.
1. PERMIT TO BE ISSUED TO: Telephone No. ,11; •i'~~. ~6'~
T,a/%d~'~t/<r.~ /~. c ~.t/~~-T//ii/~!LES ~'AL~p !~)/~
2. MAILING ADDRESS (include zip code):
Qa? ~xrx 749 ~+,/o:v~.r,% ~~ ~/~'/~
3. TYPE OF ORGANIZATION:
/corporation Partnership L-71ndividual Owner Governmental Agency
4. AGENT FOR SERVICE:
L. G' i./.sil~
5. GENERAL NATURE OF BUSINESS:
UN.Uc !d G.~20U.V4 ~~•4L ~.s/c
6. AIR POLLUTION SOURCE: Pursuant to Regulation No. 3 of the Colorado Air Quality
Control Commission, application is hereby made for an
Emission Permit} for the following air ollution source
(attach separate sheet where necessaryg:
n
TGY.~J.J~.LOM/Ey/is~; °~D.i~Oid6G.YL " /~Gk.7i`l/.~'E LG.riT.dLK /.//Yfw/c
1. SOURCE LOCATION ADDRESS:
s~g7p~/2 ; r2O-S; /?-7D-1~/T-.'~6°d'1~iYJ. COUNTY(IES): f~MOwT
8. ESTIMATED COST OF SOURCE OR MODIFICATIONS: Process
Air Pollution Control Equipment Tc~ Equipment _
Days Per Year Source Yli l l Be Operate 250
9. ST~~AT~~JJSS (check and complete applicable items):
[7fNew.Air Pollutant Source Estimated Date Estimated Date
L-TControl Equipment Being Construction Construction
Added to Existing Source Will Begin Will Be Completed
L~Activity Change /f',p,~~!/.~.>' /rlu~/~~
10. Check is enclosed to cover APPLICATION FILING FEE / $40.00
{see No. 10 on reverse side of this form)
11. ANTICIPATED START-UP DATE 12. DATE OF APPLICATION
/l/I ,c~v /~.~ /2 .?i 8z
13. SIGNAT ~~ AUTHORIZED PERSON
14. Type or print name and offic
ial
title of person signing this application.
~l
-
~o./sd<::.r/6E.i.~'idfG-/1 f~/l~/i~7widP•.d.F~~~Ai!.o. /,~.rc
Date Received 15. REMARKS:

.J
i1PG0 2006 (REV. 3/80)