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APPLICATION FOR CONSTRUCTION PERMIT OR PERMTT MODIFICATION <br />IDCEYloualn Cp~'~red t0 A! ENQ$SIQN PRRMTt'1 <br />,. <br />This application moat be filled out completely except for #14 and #15: otherwise, application will be considered incomplete <br />SEE INSTRUCTIONS ON REVERSE S1DE. Mail completed application, APENs, and filing fee to: <br />Colorado Deparanent of Public Health and Bnvlronntent <br />Air Pollution Control Division <br />X300 Cherry Crw.lc Drive South, ~lPCD-S~BI <br />Denver Colorado 40246-1330 T hone: 03 692-3150 <br /> <br />1. Permit to be issued to: S"L~ ~ ~ ~ ~- ~ cl ~ /< 9 ~fi~ f <br />2. Mailing Address: jl ~, ~ ~ D~'fit ~ ri of State: C l~ <br />Co o ra Oe~o f f ~ ./ 9 s Zi Code: oy/o <br />3a. Agen! for Service (See No. 3 on reverse): <br />3b. Federal Tax Identi lion Number: . ~ <br /> <br />4a. General Nature of Business: ~ <br />r~ /'0 ~~ 4b. SIC Code: <br />Sa. Air Pollution Source Description: C <br />- Sb. Days per year source will <br />o erate: 00 <br />r ~~ <br /> <br />6s. Source Location Address (Include Location Map): 6b. U?71I Coordinates (in km) <br />~ a9 <br />H ---- -~ <br />~~ <br />~ <br />. <br />--- - <br />~ <br />l <br />,m co~,~+Y <br />~ <br />E <br />~ <br />s <br />rn~il~, P-T y s <br />( <br />' <br />~ <br />(~'~ <br />,, <br />~ <br />~ <br />(If m(na To uidlRanaT~ ~ieee'ons and 7Fom ~e+ren ww~ or iateneedeo.) CO <br />1 ESTIMATED COSTS: AU Pollution Control Procedura or Equpmont <br />7a. Source, Process Equipment or Project: ~ 7b. Capital Cost: S <br />eratttt Cost: S <br />7c <br />. <br />. ~~ S <br /> 8a. STATUS °`~ ~ ~ <br />O Ne-v,ilrPollution Source ~"'!/~ ! rfis7i °~vey <br /> Mod cation to Permitted Source (Control Equipment added, process change, etc.): <br /> Transfer oJOwnership - TYnnsfetred from: <br /> ^ Existing Source-not permitted (Include Date of Source Start-up): <br />O Requesting to limit a source's Potential to Emit jor criteria or Hazardous Air Pollutants using Regulation No. 3 (for new and <br /> existing sources) <br />p Requesting to limit a source's Potential to Emit for Hazardous Air Pollutants only using Regulation No. 8 (for existing sources <br /> only) -/ <br />Other: C-~- ,T Lo oa ~ ~~e d A ~f n S <br /> Projected Dates for Consdudion to: ~~. ?~- . <br />8d. PrnJected Source Startup Date: _ ` _ _ l <br /> 8b. Be 'n: 8c. End: <br /> <br /> 9. Enclose check to cover.lPENFILING FEES One.iPENshould be filed for each emission point <br /> s~o7~be paa. id prior to p ~ 1 It issuance. <br />al <br />es must <br />e <br />cessi <br />ng <br />f <br />p <br />ro <br />NOTE:.lddiNonal <br /> // <br />~~ <br />~// <br />~ <br />n <br />a <br />p <br />t <br />p <br />Ai"Til~S S1VY.OU Cr APEN ~ S ~ <br /> 10. SIGNATURE OF LEG.I LLY ORIZED PERSON (~QZ Vendor or 11 a. Date Signed: I 1 b. 2 ry 4 °7 . <br />Phone:(7 -q> 39 <br /> Bquiprneryr Mant{jacturer) C _~~ o ~ Fax: (7~~) ~2 Y2y~ <br /> <br /> 12. a or Print name and o,~cial tle/e of person signing item 10. for Agency Use Only <br />DATE RECEIVED <br />14 <br /> A~ ~r f ~~ ~, H f ~ r - . <br /> _~. Check appropriate boz it you want: 15. PERMIT NUMBER <br /> a. O Copy ojpreliminary analysis conducted by Division <br /> b. D To review a draJl.of the permtt~rior to Issuance <br />4'1Cl4)POaMS.9aA1CPJlPPN.96A <br />