Laserfiche WebLink
^~ APPLICATION FOR AIR POLLUTION EMISSION PERMIT OR PERMIT MODIFICATION Y~ ~CF'(J_ <br />U <br />This application must be tiled out completely except for ,fl b 115: otherwise, application <br />will be .considered incomplete - SEE INSTRUCTIONS ON REVERSE SIDE. Mail completed application, <br />APENS, anA filing fee to: Stationary Sources Program, Air Pollution Control Division, <br />Colorado De artment of Health 4210 East 11th Avenue Denver Colorado 80220. <br />1. PERMIT TO BE ISSUED T0: <br />7Z~t~ ,~~-.~ C~.uD .Q~. <br />c. rw~t~n~ wuuntaa: - <br />P• D. ~a X .~`/~ ~ State: <br />ZIP LODE: X30 ~-J <br />3. AGENT FOR SERVICE See No. 3 on reverse ; <br />~~ <br />a. GENERAL NATURE OF BUSINESS: b. SIC Code: <br /> ~~ y~-~"'~ I/SU <br />Sa. AIR POLLUTION SOURCE DESCRIPTION: t ~~~~ Sb. <br />ays per year <br />D <br />'-4-°"-,1 u.°."cltc ~ ~µ~n~"`t . 4401. ~~' ~d0 >(~y„ .,u~ wi l l operas <br /> . <br />y <br />J~u,~ <br />a. SOURCE LOCAT 0 ADDRESS: Check i map included: b. UTM Coordinates <br /> <br /> e,o COUNTY ~C-9 JnL~~' <br />" N <br /> 2x <br />u,~ - - - - <br />- _ _ _ _ <br />7. ESTI TED COSTS: Air Pollution Control Procedures or Equipment <br />7a. Source, Process Equipment or Project: 7b. Capital Cost:$ Annualized :$ <br /> Cap. $ Annualized:$ <br />Cost: 7c. Operating Cost $ /Yr. <br />_ <br />a. STATUS <br /> ^ New Air Pollution Source <br /> Existing Source Change (Control equipment added process change, etc.): <br /> '~ Other: ~ C ~E+~J .~JO, OJO Z`0 ~~~ C~C'>" <br /> ProJected.0ates for Construction to: Projected Source Startup Date: <br /> 8b. Brain: 8c. End: 8d. <br />9. Enclose check to cover APEN FILING FEES. One APEN should be filed for each emission point <br /> APENS @ $60.00 Per APEN ~ $ <br />10. SIGNATURE OF LEGALLY AUTHORIZED PERSON NOT vendor lla. DATE SIGNED: lib. TELEPHONE NO.: <br /> equipment manufacturer): (~3).~?Stl ~~~~ <br /> i ~ ~/G <br />12. la title o parson signing item 10. <br />Ty r p <br />rin <br />ame and o Ic <br />t Aye-n-c~ Use Only <br /> n ~"• vATE RECEIVED <br /> pL <br />///1 <br />~ <br />/ <br />/~ <br />~%`I Imo- 17u ~ ._L~uS.nFS <br />~n in - <br />13. Che k appropriate box i you want: <br /> a. ^ Copy of preliminary analysis conducted by Division <br /> ^ To review a draft of the permit prior to Issuance? <br />b _ <br /> . <br />NOTE: Checking either item could result in.increased fees 15.. PERMIT NUMBER <br /> or processing time. See Reverse. <br />APCD:SSP:2000 (Rev. 1/84) <br />