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<br />FUh1TI VE GUST EMISSION PERMIT <br />Instructions <br />This form shall be used in making application for a Fugitive Dust Emission <br />Permit. Read all instructions carefully before pror_eeding to the permit <br />form. If you have any questions contact Air Pollution Control Division, <br />Colorado Health Department, 4210 East 11th Avenue, Denier, Colorado 80220, <br />Phone (303) 388-6111, Extension 371. <br />A. Applicant: Name of corporation, company, individual owner, or <br />governmental agency, that is applying for permit. <br />B. Mailing Address: Address of above-mentioned oryanization include zip <br />code and telephone number, <br />C. Project Location Address: Location of proposed project. Include <br />clear directions on how to get to project. <br />D. Duration of Project: When are you planning to start the Project and <br />how long will it take to~complete. <br />E. Describe project or activity requiring co~itrol plan. Describe nature <br />and scope (Size) of t)ie project include maps and/or drawings. Refer <br />to Regulation No. 1, Section II.D. 8 a-1, Page 1.18 enclosed. <br />F. Describe a}~atement and preventive measures that will be used during the <br />project. What specifically will be done to reduce dust emissions? <br />Refer to Regulation No. 1, Section II.D. 9 a and b, page 1.19 enclosed. <br />G. Traffic Information: Describe the number and types of vehicles that <br />will be used on the project or those that will cross over project area <br />during project period. See Regulation No. 1, Section II.D.3 (a)(a-3) <br />enclosed. <br />H. Wind: Contact nearest weather station for prevailing wind direction. <br />I. Process Information: If the project includes crushing, grinding, <br />milling, drilling, conveying or bagging processes, fill out Section I. <br />J. Cost: List cost of abatement and preventive measures; include cost of <br />controls on process equipment. <br />N. If additional space is necessary use extra paper and indicate the <br />lettered section to which the information applies. <br />Monitoring: Regulation No. 1, II.D. may require that some ambient air (surrounding <br />outside air) monitoring activity be conducted near the project site prior to <br />start up. If monitoring is required: prior notification will be sent outlining <br />monitoring that will be required before the permit is granted. <br />Mail this information to: AIR POLLUTION CONTROL DIVISION, ENFORCEMENT <br />Colorado Department of Health <br />4210 East 11th Avenue <br />Denver, Colorado 80220 <br />