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Air Pollution Control Division (APCD) - Construction Permit Application <br />PT EASE READ INSTRUCTIONS ON REVERSE SIDE. <br />I. Permit to be issued to: American Shale. Oil, L LC 1 Mailing Address: 110 E. Third Street, Suite 201 ----- <br />PO Box 1470 <br />Rifle, CO 81650 ---- <br />3. General Nature of Business: Oil shale recovery research and testing ---- <br />SIC code. (i f know4n) ---? <br />4. Air Pollution Source I)ese-iption: Thermal Oxidizer, fugitive equipment from leaks, and liquid product tames <br />(List permit numbers if existing source, NA <br />attach additional pages if needed) Is this a Portable Unit`:' 1`7u <br />5- Source Location Address (Include Location Map) ? If portable, include die initial location and home base location <br />160 acre tract approx. innately 20 miles w,cst-northwest of Rifle, CO (Ric) Blanco County). <br />Section 21, Town sh i p 2 Soul b, Range 98 West, (F 1 /2 SW 114 and the W1/2 SF '11/4) <br />Latitude = 39.858299° (,' 9051'29.88"N), Longitude = -108.399417° (108"23'57.90"W) <br />6. Reason for Application,- (Check all that apply=) <br />® New or Previously Unreported Source Ailmini.strative Permit Amendments <br />© Modification of Existing Source [] Transfer of Ownership (Complete Section 9 & 10 below) <br />Request for Synthetic Minor Permit Q Company Name Change (Complete Section 9'below) <br />0 Other: El other: <br />7. Projcctcd Startup Date: n June - Septetnbe 2010 <br />Signature ofLegally Authorized Person of Company listed in Section 1 ate Signed - <br />Roger L. Day, Vice President of Operations Phone: 970.625A324 <br />Type or Print Name and Official Title of Person Signing Above Fax: 970.625 411 -- <br />8. Check appropriate box if you want: <br />Copy of preliminary analysis conducted by Division <br />® To review a draft or the permit prior to issuance <br />77iese sections are to be completed only if a company name change or transfer of o-omership has occurred. <br />9. Permit previously issued to: NA <br />10. Transfer of Ownerslap Information <br />Effective Date of Permit Transfer: NA <br />As responsible party for the emission source(s) listed above, I certify that the business associated with this socu-c:e has becu <br />gold, and agree to transfer the permit to said party. <br />NA NA <br />Signature of Legally Authorized Person of Company listed in Section 9 Date Signed - <br />NA Phone: NA <br />Type or Print Name and Official Title of Person Signing Above ? Fax: NA _-- <br />Mail completed application, APl Ns, and filing fee to: <br />Colorado Department of Public Health and Environment <br />Air Pollution Control Division <br />4300 Cheri- Creek Drive South, APCD-SS-BI <br />Denver, Colorado 80246-1530 <br />• <br />• <br />httt7ar'??ti?zk.cd?tli state eo.t s,`apl t iLIM11in.litsrtl <br />Phony (10.3) 692-3150 <br />Revised august 2004 <br />Page 4 of 46