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San Joaquin Valley Air Pollution Control District <br /> w".valleyair org <br /> Permit Application For: <br /> AUTHORITY TO CONSTRUCT (ATC) -New Emission Unit <br /> [ AUTHORITY TO CONSTRUCT (ATC) -Modification Of Emission Unit With Valid PTO/Valid ATC <br /> [ AUTHORITY TO CONSTRUCT (ATC) -Renewal of Valid Authority to Construct <br /> PERMIT TO OPERATE PTO -Exisft Emission Unit Now a Permit to OpErate <br /> 1 PERMIT TO BE ISSUED TO y �+ <br /> 1An�iL R i Ck�`I t1d Com aft <br /> 2 sMAILING/P saADDRESS 3, <br /> Cny QL [_ STATE 9 DIGIT Q (� S;-7 O <br /> ZIP CODE l l <br /> 3 LOCATION WHERE THE EQUIPMENT WELL BE OPERATED WITHIN 1,000 Fr OF A <br /> sTREET 6 ast- 4 pir y hg vel a V rr A Cny_S fio L k-+n n SCHOOL? [ ] YES N NO <br /> q SECTION TOWNSHIP l 1� AGE G S I C CODE(S)OF FACH= <br /> (7f kuowo) <br /> 4 GENERAL NATURE OF BUSINESS G a so 1 i 1V-- „Se.r v i c.e 9t0-i0(\,, Ca u e r,, o A-e INSTAR.DATE <br /> S "f e <br /> 5 TITLE V PERMIT HOLDERS Do you request a COC (EPA Review)prior to receiving your ATC? [ ]YES [ J NO <br /> ONLY <br /> 6 DESCRIPTION OF EQUIPMENT OR MODIFICATION FOR WHICH APPLICATION IS MADE(include Permit#"s if known and use <br /> additional sheets tf necessary) MJte-,&.Ct*i orX ©T� <br /> 61,2aenefol— M+aE Wilk CoaSiS'i- o-P xrtt+er `rhro"h v^ ait- <br /> ct-T-N"r- (6 tr&,ig" 2o3p�, Z.,P c.�,r+�� 0-03) 2y�- 16 Garban vQSSe(S,{;,iler- t- f0wkt) <br /> S0"11 VA�Por VjC++-otC+roA eyS+0� "I- rQ0V-d1ai--Ion 0-f 94s�J'tWj 1On2 �O, , //'11-�E �dsa,hnd <br /> 0 So i t ; sa> 0X i d;az r d.- V��n+ �-1n o uc��n I Z rt�g,� S rLuR r-C <br /> 6, +te.a*a by 1-ha t+&r WA[ OK i ej j? f- <br /> 7 HAVE YOU EVER APPLIED FOR AN ATC OR [ ]YES ><NO Optional Section <br /> PTO IN THE PAST? If es, ATC/PTO 10 CHECK WHETHER YOU ARE A S <br /> y PARTICIPANT IN ETIHER OF <br /> 8 IS THIS PROPERTY ZONED PROPERLY FOR THESE VOLUNTARY PROGRAMS <br /> THE PROPOSED USE? M YF-S [ ] NO "SPARE THE AIR" <br /> 9 IS THIS APPLICATION SUBMITTED AS THE [ ]Yes [ ]Na [ ]Send info <br /> 1i14p6 <br /> RESULT OF EITHER A NOTICE OF [ ]YES jjC]NO "INSPECT" <br /> VIOLATION OR A NOTICE TO COMPLY? If yes,NOV/NTC# [ ]Yes [ ]No [ ]Send info <br /> 11 TYPE OR PRINT NAME OF APPLICANT TITLE OF APPLICANT <br /> B,rI(AA c4xfe - SELGoR in nat-:ana[renc, C-o^svl1-anM <br /> 12 SIGNATURE OF APPLICANT DATE PHONE# [ $61-0+4 00 X <br /> $f3o foZ FAX # (a16) 86t-oti 10 <br /> 1 ! E-MAIL bGara Q.$eCor-, CoM <br /> FOR APCD USE ONLY <br /> DATE STAMP �'�G FEE <br /> RECEIVED $ CHECK# <br /> DATE PAID <br /> PROJECT# FACILITY ID <br /> . Nortliern Regional Office*4230 Kiernan Avemie, Suite 130*Modesto, CaMmia 95356-9321*(209)557-6400*FAX(209)557-6475 <br /> Central Regional Office*1990 East Gettysburg Avenue* Fresno,California 93726-0244* (559) 230-5990*FAX(559)230-6061 <br /> Southern Regional Office 112700 M Street,Suite 275*Bakersfield,California 93301-2370* (661) 326-0900*FAX(661)326-6985 <br /> RM J*mm <br />