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AlN PU),h11'fION~NTIt01, hiVISION - CULORnDO DF:I'A~ad'L' OF IIF',AL'1'll <br />A210 E. 11th Ave „ Denvnr. Cnl.oradn - A07.70 - Ph: 388-G111, F.xt, 371 <br />APPLICATTON FOR F.MTSSiON PERMIT <br />This application stial.l be filled out completely: s!~e instr~rctions on reverse side. <br />1, PERMIT TO BF, 15SUF.D 'f0 Telephone No, ~L' ~~r < r- C• <br /> r <br />1 ~~II '_~ <br />~ ~ ~ <br /> , r. r <br />2, MAILING ADDRESS (include Zip Code) <br /> , <br />Z- <br />= <br />j <br />~ <br />. <br />3. _ <br />__ _ <br />'-- --- <br />~-- ----- <br />-- <br />TYPE OF ORfANIZATION ' <br /> CorporationPartnership Individual Owner ~ Governmental Agency <br />4, GENERAL NATURE OF 6USINESS <br /> ~ <br />S. EQUIPMENT - Pursuant to Regulation <br />No. 3 of tl~e Colorado Air Pollution Control <br /> Coimnission, application is )iereby made for an Emission Permit for <br /> the following equipment; (Attach separate sheet where necessary) <br /> <br /> i <br />6, EQUIPMENT •'.LOCATION ADDRESS : <br />, <br /> r <br /> _~ <br />I ~ I Count; ~~ <br />1 ~ <br /> , <br />r. <br />7, _ <br />ESTIMATED COST OF EQUIPMENT OR AL1'EP,ATTONS <br /> _ _ <br />Air Pollution Control Equipment's.'' ~ Basic Equipment ~~' r' r r <br /> Days per year equipment will be operated ' <br />8, STATUS (Check and compl ete applicable items) <br /> ~! New Air Contamination Source Estimated Date Estimated Date <br /> Construction Construction <br /> Control Equipment Being Added Will Begin Will be Completed <br /> to Existing Source ~~ - ~- "r % ` I ~ "a ( ~` - `1 i <br /> <br />9, Check is enclosed to cover APPLICATION FILING FEE ~ $40.00 <br /> <br />10, SIGNATURE OF LElJ+LLY AUTHORIZED PF.RSUN 11. DATE OF APPLICATION <br /> <br />12, Type or print name and official title of person signing this application. <br /> Date Received <br />nrr'n ?nnr. <br />