Laserfiche WebLink
., S~~ . T-,t.-r-"~ ~ fp III IIIIIIIIIIIII III Doc Date:12/11/2 / y7-, J <br />Please print or type in the unshatlea great only /••G~ <br />(sill-rn areas art roacrd for alive type, i. e., 12 charac tors/neh1. Form Apprpved OrAB No <br />FORM UJ. ENV INONM[NT A.L fROTfCT10N Accncr ~ 1. EPA LD. NUMBER t <br />~ GENERAL.fMFORMATION;.;c` <br />~,,, I tL`Al.~'~~~ .6ynio/idrn.hnnlsPrymr' :'';f F C 0- 0 0 3. 3 <br />.111. FACTI LITY~ I'lestern Slope Carbon, Inc. <br />P.O. Box 1526 <br />''~ AGILITY ~ ~~ Salt Lake City, Utah &x'110 <br />V' MAI ING ADDR E55~ <br />Sonerset, Colorado 81434 <br />POLLUTANT <br />f a preprirtted label het been provided, etfi{ <br />t In the deti;natad spec. Review the inrorm- <br />tion carefully; It my of it It incorrect, crow <br />hrouph it antl enter the correct date in the <br />pprotxieta filltin ena below. Also, it any o1 <br />he preprinted data is eDsenti (the aros ro Me <br />eft oI Me label rpaee Ilrtr the in/omlation <br />het should appear), Dleate provide It In the <br />eoper ftli~n erea(t1 below. If the label It <br />omDlah end correct, you need nos complete <br />tome: l; III, V, antl VI lercept VI-B which <br />toot be completed rapardlesrl. Complete ell <br />tame ;If no label hp been provided. Refer to <br />ha: inRlVL'tiont for derailed item detcrip- <br />lone.end for ehe lepat eutnorizationt under <br />rhleh thlt date it t:otlected. <br />''.INSTRUCTIONS: Complete A through J to determ(na Yvttetlttll YDV natd m submh gay pf(mit application forms to thf EP0. It you anmer "yu" to any <br />quertioru, you must submit this form end the supplementd 1Dmi 1'et!d in thti~perenthe~s.fd'lowing the question. Mark "X" In the host in the third column <br />' if the supplemental form is attfched, If you ansxtr "w° tll tech gEasticp;'(Cgrleed not wbmlt any of these forms YOU meY answer "n D" if your activity <br />is ez:luded from pertlit requiremenu; 4e Se:tion G of L`e intt:u[ors ~5cf.aS:li; Sec:ifm l1 ot~tha iristrttetions tot definitions of bold-feud bane <br />ae ECI VIC OUCS-IONL '~~ <br />.A. It this facility a publicly o'xned treetmMt verkf <br />w`.ich rosu its in a discharge to svrten of the U.S7 <br />IFOn^fA 2A1 ' <br />Is the a fen.~ty wh¢~ current y yew tr m la ayes <br />10 water/ o1 the U.S. other then Ihosa tle;Cibed in <br />A or B epos•et !FrJnM 2C1 ' <br />oes or will this fac~lity treat, :tore, or ditpo:e of <br />•ardour warts) IF ORM 3) <br />water or other fluiCS which are Drought to the surface <br />•. in cennacLOn with conventional oil or nalnrel pas pro- <br />duction, insect Ilu~d+ u+etl fo• rnh.enced recovery o1 <br />• oil or natural gas, or ~niect fluids for slorepa of liquid <br />one or the 28 ;ntlustriel categories listed in the in- <br />•~. rtructiom antl which will potentially emit 1C0 tom <br />';' per ypr of any air pollutant regulated under the <br />Clean Air Aet antl mev effect ar be Ixated In en <br />~• ~ etteinment area? (FORM 51 <br />cll. NAh1E OF FACILI~~~~~-'~~+''~?~'+ .z <br />c ~ r I <br />t'""l•Jes tern 51 ooe C <br />A. NAME O TITLC <br />•{• MO rLeY <br />• r. {ue <br /> X <br /> <br />X <br /> <br /> X <br /> <br /> x <br />++ a• •a <br /> X <br />" ' ^I[CI-IC GUEf TIpNf "" .{• "o { <br />8. Dce1 or. rdll thle focN ny lsi;hx mrirtlnp or prDporedl <br />.. Irdudf a~0onpntratad animal feeding operation or t <br />fquftie aNnrel produKlon fecllfty which resulu in e X <br />' di :lrcrp to watts o1 the U.S.T !FORM 2B) <br />1 <br />rI <br />. re tnd 1 prpppfed ea rtY o sr nr ore [sprl ~ I <br />-~: br A or B ebovtrl which will result in a SRLisarpe to <br />• e U 7 (FORM 2D <br />, <br />r' <br />F, Oo you ei will you infect at :his facility Industrial or <br />mun:eipal afllucnt below the lovrermost erratum con• <br />bininp, within one quarter mite of the well Isore, 'X <br />:. underground source of drinking ureters IFORtJ 41 <br />H. 0o you or wHt you inJaa M chit facility Huids for tpe• , <br />ales DroCYESp ouch a7 mining o1 sulfur by the Frasch <br />~, prtscen, ulutlon minirT3 of minerele, In situ oombus• K <br />lion of fonll. coal, or racowry of peotMrmel energy) <br />' • (FORM 4y <br />J. a tme acs Iry a Prepos ate: ry eouru w Ic n <br />' NOT orsa o1 the 28 InCustrial cat>gories listed in the <br />. irlstruellent and which will potentially emit 250 cons x <br />per yf{r o} any air pollutant regulated under the Cleeri <br />~:~ Alr Act antl mfg effect or be located In en Irttalmmer+t <br />....: tcngLt 51 ~ .. .. .. .. <br />arbonInc. <br /> <br />.V. FACILITY h7AI LING ADDRESS eLa ~~~^+,2.a'Jn~.~'i.'r~d '~ ~"~}Y$~ <br />A. sT REEr oR -.o. cox <br />.a ; <br />3 a. CITY OR TOwN 0.aTAt <br />c <br />a Sal t L a k e U T <br />VI. FACILITY LOCATION s'~~iJ,;°-> ':::., .. ~ _ <br />A. aTR[ET. ROUTE NO. OR OTNCR VECIe1C IDEN TI TIER-: ~. I~ r <br />a. COUNTY nAM[ <br />T'T1 ' ~ T-T-r7T- <br />ison _ . <br />C~ CITY ~'., TOwN <br />-r-T-~'TT~T--r. ~_ <br />a,., ._ ~__._ _.. _ _ . <br />.- . <br />. - •...C ID.aTI <br />.. p. rn OnE (ena code a no./ <br />8 0 1 3 4 3 4 7 0 <br />~. i' <br />o•xv coos ~ ~ ~ ~ <br /> <br />