Laserfiche WebLink
APPLICATION' FO CONSTRUCTION PERMIT OR PEI• MODIFICATION <br /> i ( reviousl referred to as EMISSION PERMIT) <br /> This application must be filled out completely except for#14 and,715: otherwise, application will be considered incomplete <br /> SEE IN <br /> ON REVERSE SIDE. Mail completed application, APENs, and filing fee :o: <br /> Colorado Depamnent of Public Health and Environment <br /> Air Pollution Control Division <br /> 4300 Cherry Creek Drive South, APCD-SS•BI <br /> Denver, Colorado 80246.1530 Telephone: (303)692-3150 <br /> 1. Permit to be issued to: <br /> Z. Mailing Address: Stare:CO <br /> , <br /> loxr <br /> O/(/ e- Zip Code: cN1'/.Z2 <br /> 3a. Agent for Service (See No. 3 on reverse): F/ZFirlo <br /> . Federal Tax Identification Number: 8 y 6— QOO -- 78"S <br /> 4a.:EGoralNature of Business: 4b. SIC Code: 1vZ <br /> f / G <br /> 5a. Air Pollution Source Description: 5b. Days per year source will <br /> ZE er&0 -C Lvd operate: 0 ?00 <br /> ! 6a. Source 6b. UTM Coordinates (in bn) <br /> Sechaq 36. W1Z&,0erAe r 7 of Clt X$(�CcPp�r Gr h!i Rd� � � c/57 J� (�2�/SoV <br /> M.4s st✓ o{ Pc.-,ode&_, Cc. <br /> 1 (If using Township and range,give directions and d utrw from nearer town or Intersection.) County: rerr le7 <br /> , <br /> 7. ESTIMATED COSTS: Air Pollution Control Procedures or Equipment <br /> 17a. Source, Process Equipment or Project: 7b. Capital Cost:S <br /> �. Cap. Cost S 7c. Operating Cost: S <br /> 8a. STAPUS <br /> N New Air Pollution Source <br /> j ❑ Modification to Permitted Source (Control Equipment added, process change, etc.): <br /> ❑ Transfer of Ownership — Transferred from: <br /> ❑ Existing Source-not permitted (Include Dare of Source Start-up): <br /> ❑ Requesting to limit a source's Potential to Emir for criteria or Hazardous Air Pollutants using Regulation No. 3 (for new and <br /> i, existing sources) <br /> ❑ Requesting to iunit a source's Potenriai to Emir for Hazardous Air Pollutants only using Regulation No. 8 (for existing sources <br /> only) <br /> ❑ Other: <br /> Projected Dates for Construction to: <br /> 78d. Projected Source Startup Date: CR ;Zoomj8b. Begin: S ni Z002 8c. End: w/G z <br /> 9. Enrlose check to cover APEN FILING FEES. One APEN should be filed for each emission point <br /> NOTE: Additional processing fees must also be paid prior to pem+it issuance. <br /> APENS 0$100.00 per APEN = S <br /> 10. SIG OF LEGALLYA ORIZED PERSON tNOT vendor or 1 la. Date Signed: 11b. <br /> E ' ment M rfact Phone:( ) <br /> Fax: ( ) <br /> 12. Trpe r Print n me and o cial :isle of person signing item 10. or Agency Use Only <br /> i <br /> 14, DATE RECEIVED <br /> I <br /> 13. Check appropriate box if you want: 15. PERMIT NUMBER <br /> a. ❑ Copy of preliminary analysis conducted by Division <br /> b. ❑ To review a draft of the permit prior to issuance <br /> trpnpnpm wAlrp APpN ova <br />