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<br />~ , <br />INSTRUCTIONS FOR THE COMELETION OF THE FOR."". <br />APPLICATION FOR EMISSION PE&`!IT <br />COLORADO AIR POLLUTION CONTROL DIVISION <br />The, following instructions for the completion of the Application for Emission <br />Permit are titled, Lettered, and numbered the same as the applicable sections <br />of the form on the other side. <br />1. PERMIT ISSUED T0. List the business license name o.f the corporation, <br />company, individual owner, or government agency chat is to operate the <br />equipment. <br />2.' MAILING ADDRESS. ' <br />3. TYPE OF ORGANIZATIOPI, <br />4, GENERAL NATURE OF BUSINESS. List the business activity; for example, <br />meat packer, saw mill, furniture manufacturer, commercial printing, <br />fire retreading, etc, Also list type of business activity per <br />Standard Industrial Classification (S.I.C.). <br />S. EQUIPMENT. List common name of: <br />a. Basic Equipment: This class includes any article, machine, <br />equipment or contrivance, the use of which may cause"the <br />issuance of air contaminants. <br />b. Air Pollution Control Equipment: This class includes any <br />article, machine, equipment or contrivance, the use of which <br />may eliminate, reduce, or control the issuance of air contaminants. <br />6. EQUIPMENT ADDRESS: If the equipment-is portable, list the locations and <br />dates where equipment will be operated during, duration of permit .period. <br />Please include a map indicating the exact location and showing major <br />topographic features. <br />7. ESTI:^ATED COST OF EQUIPMENT OR ALTERATIONS. Enter estimated cost of Air <br />Pollution Control Equipment and Basic Equipment as described under 5 above. <br />S. PRESENT STATUS OF EQUIPMENT. Check one box applicable to status of equip- <br />ment. Two dates required. <br />9. APPLICATION FEE. Pay only $40.00 Filing Fee at this time. In accord with <br />Air Pollution Control Commission Regulation No. 3, II.K., initial <br />and final approval fees shall be requested by separate letter. <br />10. SIG;IATURE OF LEGALLY AL"THORIZED PERSON. The form must be signed by a person <br />Legally responsible for his action as agent of the organization listed in <br />Item 1. <br />11. DATE OF APPLICATION. <br />12. THIS APPLICATION MUST BE SIGYED 8Y THE INDIVIDUAL(S) RESPONSIBLE FOR AL~TJ <br />AUTHORIZED TO ACT ON BEHALF OF THE APPLICA.~fi, <br />