_PERMIT FILE - M1994096

• Permit No: M1994096
• IBM Index Class Name: Permit File
• Doc Name: APPLICATION FOR AIR POLLUTION PERMIT MODIFICATION
• Media Type: D
• Archive: No

t APPLICATION FOR AA POLLUTION ( III IIIIIIIIIIIII 'll IMTT OR PERMIT MODIFICATION
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This application must be filled out completely except for#14 and#15: otherwise, application will be considered incomplete- SEE
INSTRUCTIONS ON REVERSE SIDE. Mail completed application APENs and filing fee to:
Colorado Department of Public Health and Environment
APCD-SS-BI
4300 Cherry Creek Drive South
Denver, Colorado 80222-1530 Telephone: [phone]
1. Permit to be issued to:
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2. Mailing Address: State. C
•) d o. � J W� e ( l vI --. Q tip Code. 90 S�Q
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3a. Agem for Service (See No. 3 on reverse): /U
3b. Federal Tax Identicotion Number. ,j.2 3 — (a v--
4a. General Nature of Business: 4b. SIC Code.•
rave ( , f
5a. Air Pollution Source Description: 5b. Days per year source will
operate: d
6a. Source Location Address (Include Location Map): r/=Sy„'' cA) C� ; r 11 y f ar,ca 6b. (17M Coordinates rn km)
SEt/�f �✓ W 'Ay, Sc 1/4 --- —V
Tq �) . 9 (08' w
Of-q T--*d a.�,0.ram dd: t—e,a.n a>hr .) County: L4 ri M el-
7. ESTIMATED COSTS: Air Pollution Control Procedures or Equipment
7a. Source, Process Equipment or Project: 7b. Capital Cost. $
Cap. Cost$ 7c. Operating Cost: $
8a. STATUS
❑ New Air Pollution Source
❑ Modification to Permitted Source (Control Equipment added,process change, etc.):
❑ Transfer of Ownership — Transferred from:
Existing Source- not permitted(Include Date of Source Star-up): I qff 3 —
❑ Other.
�Nd+ +rely Coutr �I,e,•J
Projected Dates for Construction to: Projected Source Startup Date:
8b. Begin: D-cl v, , / q ?. 8c. End: O '�Ol Sd. (( a vt i: s u a me e- o P e r 41,•6
9. Enclose duck to cover APEN FILING FEES. One APEN should be filed for each emission point
NOTE- Additional processing fees must also be paid prior to permit issuance.
- 4n-w f APENS @$100.00 per APEN = $ /n n
10. SIGNATURE OF LEGALLY AUTHORIZED PERSON (NOT Vendor or I la. Dale Signed. 11b. Telephone No.:
i mManu acturer)
'� I /lI U✓, �/ 13 Oj 1
12. Type o Print and official title of person signing item 10. \\
_ A2encv Use Only
De I if- J - Ace SS e // , d w H e `� 14. DATE RECEIVED:
13. Check appropriate box if you want:
a, Q Copy of preliminary analysis conducted by Division
b. 0 To review a draft of the permit prior to issuance? 15. PERMIT NUMBER
Noe: mate uS�era ma,s,p I.med(�d/>pua.q lira.Sm Re•awe.