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<br /> <br />This application must be filled out completely except for 014 L K15: otnerwise, application <br />will be con3idered incomplete - SEE INSTRUCTIONS ON REVERSE SI DE. Mail completed applicatio <br />APEHs, and fllinq fee to: Stationary Sources Program, Al r. Pol lution Control Division, <br />Colorado Department of Health 4210 East Iltn Avenue ' Denver Caiorado 80220. <br />I': PERMIT 70 BE ISSUED T0: <br />~ <br />~~ <br />v <br />. <br />o <br />2. MAILING ADDRESS: <br />~", ~~ <br />/J / State: O 4 <br />21P CODE: <br />" <br />Z 1. y~ h ~~ .._~ ~O ~ <br />AGENT FOR SERVIC <br />E See No. 3 on. reverse ' <br />/ <br />`~' CJ l /O ~e s S <br />a. GENERAL NATURE OF BUSINESS: b. SIC Code: <br /> \~`.. <br />5a. AIR POLLUTION RCE DESCRIPTION: Sb..Days per year <br /> .',s'oUrcc will ape r, <br />. <br />1 ~ ~~ ~ <br />a. SOURCE L CATIOr AD p~/,ESS: ~ Check~yf map included: <br />6 h/!~•/P 5 ~61^~f~ ~~/iNa T7' b. UTM Coordinates <br />(in ksn): <br />\ <br />COUNTY 8 S U ~~_ _ H _ <br />_ <br />7. ESTIMATED 00575: Air Pollution Control Procedures or Equipme <br />7a. Source, Pro ss Equipment or ProJ'ect• 7b: Capital Cost:S N ~ Annualized:$ <br /> <br />Cap• A~/P Annualized:$ ~ • <br />Cost•$ <br />7c. Operating _ <br />Cost $ /y r. <br />tsa. STATUS i <br />^ Hew Air Pollution Source ' <br />^ Existing Source Change (Control equipment added, process change, etc.): <br />^ Other: <br />Projected.Dates for Construction to: Projected Source Startup Date: <br />As Sow ,, ds / ~r~s' <br />8b. Beain:'r;r w~dis 8c. End: Bd. <br />9• Enclose check to cover APEN FILING fEES. One AREN should be filed for each emission poin <br />APENs p $40.00 per APEN = $ <br />10. SIGNATURE OF L LY AUTH RIZE ERSON NOT vendor Ila. DATE 5 GNED: Ilb. TELEPHONE 110.. <br />or equipment a facto e <br />C3 ~3) / a- ~ -~L!/ <br />~ / '(/ ~~ <br />3 <br />12. Type or print nam nd official title of person signi g i. m 1 <br />0. A ency Use Only <br />/ 14. DATE RECEIVED <br />/ <br />~ U, <br />d CJ~SS -~ G~ c.(/ Yl ~ ~~ <br />13• Check appropriate box if you want: , <br />a. ^ Copy of preliminary analysis conducted by Division <br />b. ^ To review a draft of the permit prior to issuance? <br />110TE: Checking either item could result in increased fees 15. PERMIT NUMBER <br />or processing time, See Reverse. <br />APCD:SSP:~2000 (Rev. I/84) <br />r- <br />~ _' <br />