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i <br /> INSTRUCTIONS FOR THE COMPLETION OF AN <br /> APPLICATION FOR AN AIR POLLUTION EMISSION PERMIT <br /> The following instructions for the completion of the Application for Emission Permit art tilled, lettered,and numbered the same as the applicable sections of the form on the <br /> other side. If a section does not apply,write 'N/A':DO NOT LEAVE BLANK. <br /> N TF.: All information submitted as par of this permit application and all data generated by the Division as pan of processing this permit will be considered open to the public <br /> unless confidential treatment is requested in writing. All such materials MUST be (1)clearly marked 'CONFIDENTIAL'and(2)enclosed in a ietlante sealed envelope <br /> marked*CONFIDENTIAL INFORMATION'to ensure against accidental release. Confidentiality is granted only if the release of such information would result in economic <br /> disadvantage to the applicant. If confidentiality is requested, the Division will notify you of its decision and, it denied,allow time for you to present additional evidence <br /> justifying the need for confidentiality. In general,confidentiality requests will increase permit processing time. Under no circumstances can emissions data be held confidential. <br /> 1. PERMIT ISSUED TO: List the name of the person(e.g.,corporation,partnership,association,individual owner,or governmental agency)to whom the permit <br /> is to be issued and who will therefore be responsible for the operation of the source. <br /> ].a. AGENT FOR SERVICE: This is the person or company legally responsible for all permit actions;this name is filed with the Colorado Secretary of State. If there <br /> is no'Agent for Service,-write 'N/A.' <br /> J.b. Federal Tex ID Number as on record with Department of Revenue. <br /> 4. GENERAL NATURE OF BUSINESS: List the business activity(meatpacker,saw mill,furniture manufacturer,commercial printing,Lire retreading,etc.). Also, <br /> list the Standard Industrial Classification(S.I.0 J for this type of business activity. <br /> 5.0. AIR POLLUTION SOURCE DESCRIPTION: Provide a brief description of the equipment being permitted and the associated emission controls(e.g.,coal fired <br /> boiler with baghouse,paint booth with particulate filters). <br /> NOTE: More than one Air Pollutant Emission Notice(APEN)may be needed with this application,if there a multiple sources. Only one application form needs <br /> to be completed. <br /> b. List the maximum number of days per year that the source will operate. <br /> 6.s. SOURCE ADDRESS: Do not give a P.O. Box. This is for the physical location of the source. Please include a map which indicelee the exact location and shows <br /> major topographic features. If the source is portable, include the locations and dates where the source will be operated during duration of permit (if known); <br /> otherwise,list first operating location. <br /> b. UTM coordinates are shown on US Geological Survey(1'opo)maps(list latitude end longitude if UTMs not known). <br /> 7.a. ESTIMATED COSTS: Source- Enter estimated capital cost of the entire source(including control equipment). <br /> b. Air Pollution Control Equipment- Enter the capital and&must operating costs of the control equipment only. <br /> S.d. ESTIMATED START-UP DATE: This estimated date allows the Division to anticipate when the required inspection for foal approval will be conducted. If the <br /> project consists solely of an activity, e.g., land development,the dates in items 8b and 8d will be the same. N TE• Operation prior to receipt of a permit is <br /> prohibited by Colorado Statute. <br /> 9. APEN FILING FEE: Pay$I00.00 filing fee per APEN at this time. Initial and Final Approval Fees will be assessed on an hourly rate during processing and will <br /> be requested by separate letter. ANNUAL FEES WILL BE BILLED FOR EACH SOURCE REQUIRING AN APEN TO COVER THE COSTS OF <br /> PERIODIC INSPECTIONS AND ADMINISTRATION. Annual rees arc baud on the quantity and type of pollutants entitled. For specific information related <br /> to fees ace AQCC Regulation No.9,Section VI. <br /> 13.e. The cod of copying and mailing the analysis will he charxd to the n pplicarn. Proceseiry delays mey occur V there arc qucn:o,,regarding the analysis. <br /> b. Review requests will usually add to both processing coda and processing time. The Division will consider the request an official extension of the proceasing <br /> deadlines specified by the Act. The extension will consist of the number of days elapsed between Division mailing of the draft permit to the applicant and receipt <br /> of the applicant's comments by the Division,not to exceed IS days. However,the Division is not bound to consider any comments received after the 15 day time <br /> period lapses,unless both the Division and the applicant agree to a fuller extension of the processing deadlines. Any additional time and charges incurred by the <br /> Division in providing a draft and cormirpundence with the applicant will be billed to the applicant. <br /> NOTICE: ONCE AN APPLICATION IS RECEIVED,ALL PROCESSING TIME WILL BE CHARGED REGARDLESS OF WHETHER A PERMIT IS ISSUED <br /> OR NOT.IF A PROJECT IS CANCELED,THE DIVISION SHOULD BE NOTIFIED IN WRITING IMMEDIATELY, STATE LAW REQUIRES THAT EMISSION <br /> PERMITS MAY NOT BE ISSUED UNTIL PROCESSING FEES ARE PAID. PROCESSING FEES ARE BASED ON THE AMOUNT OF TIME SPENT <br /> REVIEWING THE APPLICATION AND ISSUING THE PERMIT. <br /> I <br /> it <br />