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wlor,kdo Dcpartmcnt of Public IHcalth and Fnwvironmew <br />Ayr Pollution Control Division <br />Bill Owens. Goverrior <br />Aenrwa a. Ellis, Executive Director <br />L s,_0L0RAD(.-- <br />Pedlcat[W to prote=ng ane imtirtwinq thO hoafth anu envir?r,miint of the people ar Guioraao <br />x340 Cherry Croak Qr. S. <br />Donver. Colorado 80246.,1531) <br />phone (343) 61.2•.rwo <br />TOD Line (304) Ot11-7700 <br />Lac"ld in OlpndWs. Laorado <br />ritra?l.?urww.edpho, stata.oo,i,s <br />rAborsatorp Seryieer: Oiviaion <br />1140 Lowry P;vd <br />00"11er. GoloraW W230.69,?p <br />(M1) 892-w9c <br />AIR POL+LL'7'ION CONTROL DIVIRON CONSTRUCTION pFRN117 <br />FINAL APPROVAL SE1Y-CF TIFICATr0r4 FOI;tm <br />StItIRCFNAME: [insattCompanyNttrne] FACILITY IDENT7FICATION NUMBER: (InscrtAlPS n,mi eri ) z <br />'The AIRS number is found in the lowcr left corner of thr perrtu t) <br />PE7i11, rT NLYMBE.R: (Insert Construction Perrr ii Nwilber:i 06k i11.$?_E <br />Date Signed <br />Alit he be erred ad by by a a r r relted tcesporite Final Apnti?vhl ceriificdl;i?ln of the abov,? ; 4fercnred 1_nitial Approval construction perm;; <br />he I certifiensible afF.rinl as define" Ob the armched p,agr. This certification ;hcans that each condition of <br />e Initial Approve parntit has been seriewed and the the source is ill compliance with a.ll c4nditirns Ol`the pettrl;r. A <br />Final Approval befall will be issued onl if all <br />What eta s must be Y permit conditio-w. are being met. The atkrched memo provides guidance on <br />p s to eerrify cot't Pliance ; i:lj ,.a? ypus typ s of pcroit conditions. This signed certification docamcnt <br />must be packaged with the documents brine submitted for the requcs: for Final .Approval Of this Permit. A separate <br />Certification along with the associated dactirientation is required Jor each individual initial Approval per'mir, This <br />uicludes "clash numbered -permit" ie.g. 96LA199-2). <br />1 have reviewed the above paragraph, the attached document entitled MCaidxnce for Self-Certification", terms .,itd <br />conditions of the initial approval permit referenced above, and the information being submitted for ffuW approval <br />of this permit is its entirety. Based on information and belief formed after reasotsable inquiry, I certify that the <br />source Is in full Compliance with each permit and condition of this initial approval permit, and the "tatemen% "tie <br />Information contained In this submittal are true, accurate and cornpleto. <br />Please note that the Colorado Statute$ state that any Rtrson who knowingly, as defined In § 1R-1-:;01(6), C.lt.S., <br />makes any false material statement, representation, or eertifieaho" in this application if guilty of a misdem"no <br />and may be, punished in accordance with the provisions of $ 25.7122.1, C,R.& <br />_..__Shristo her L.. Varna <br />rTinted tr 7)ped Narner - _ Pra. si er. C- <br />Signature <br />k:TOMMSTA terns: SF4FCER-rx)0C <br />Colorado Dcpanrrlent <br />of Public Health <br />and Pnvir0nm,nt <br />Krn,is(,; )-t e; <br />F-11 TT T :_i4dCt_i ^;Jdr, t M30ZLbrr.0F f_N 't? I '.'%tic'. i sri./Gll