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Colorado Deparment of Public Health and Environment <br />Air Pollution Control Division <br />- LAND DEVELOPMENT - <br />III. Prevention Of Mud And Dirt Carried Out Onto Paved Surfaces. <br /> <br /> <br />Prevention <br />® Gravel Entry Ways <br />^ Washing Vehicle Wheels <br />^ Other: <br />Clean up of Paved Areas <br />® Street Sweeper <br />^ Hose With Water <br />^ Other: <br />Frequency: <br />Additional Sources of Emissions <br />List any other sources of emissions or control methods <br />None <br />Times Per Day <br /> <br />Signature <br />~ ~~ <br />i, <br />~~ ~G' ~ _ <br />a Responsible Official (not a vendor or consultant) <br />Name (please print) <br />Check the appropriate box if you want: <br />® Copy of the Preliminary Analysis conducted by the Division <br />® To review a drafr of the permit prior to issuance <br />(Checking any of these boxes may result in an increased fee and/or processing time) <br />Date <br />Owner <br />Title <br />Send this form along with $119.96 to: Colorado Department of Public Health and Environment <br />Telephone: (303) 692-3150 Air Pollution Control Division <br />APCD-SS-Bl <br />4300 Cherry Creek Drive South <br />Denver, CO 80246-1530 <br />Small Business Assistance prooram <br />(303) 692-3148 <br />Small Business Ombudsman <br />(303) 692-2135 <br />/~ ~; 1-0~ <br />Revised July 2001 httn~//www cdohe state co us/ao/stationary asp <br />