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San Joaquin valley Air Pollution Control District <br /> www.valleyair.org <br /> Permit Application For: <br /> [ ] AUTHORITY TO CONSTRUCT(ATC) -New Emission Unit <br /> [ J AUTHORITY TO CONSTRUCT(ATC) -Modification Of Emission Unit With Valid PTO/Valid ATC <br /> [x] AUTHORITY TO CONSTRUCT(ATC) -Renewal of Valid Authority to Construct <br /> [ ] PERMIT TO OPERATE(PTO) -Existing Emission Unit Now Requiring a Permit to Operate <br /> 1. PERMIT TO BE ISSUED TO: <br /> ARCO#6100 <br /> 2. MAILING ADDRESS: <br /> STREET/P.O.BOX: 25775 S.Patterson Pass Rd. <br /> 9-DIGIT <br /> CITY: Tracy STATE: CA ZIP CODE: <br /> 3. LOCATION WHERE THE EQUIPMENT WILL BE OPERATED: WITHIN 1,000 FT OF A <br /> ! STREET: 25775 S.Patterson Pass Rd. CITY: True SCHOOL? [ )YES [X)NO <br /> S.I.C.CODE(S)OF FACILITY <br /> /4 SECTION _ TOWNSHIP RANGE (If known): <br /> 4. GENERAL NATURE OF BUSINESS:Retail Gas Station ! INSTALL DATE: <br /> ii <br /> 5. TITLE V PERMIT HOLDERS ONLY: Do you request a COC(EPA Review)prior to receiving your ATC(Ifyes, [ ]YES [ ]NO <br /> please complete and attach a Compliance Certi cation form(rVFORM--009)? <br /> 6. DESCRIPTION OF EQUIPMENT OR MODIFICATION FOR WHICH APPLICATION IS MADE(include Permit#'s if known,and use <br /> additional sheets if necessary) <br /> + Replace 4"diameter steel risers @ MIS and VRs to meet proper install height. <br /> 7. PERMIT REVIEW PERIOD: Do you request a three-or ten-day period to review the draft Authority to Construct [ )3-day review <br /> permit?Please note that checking"YES"will delay issuance of your final permit by a corresponding number of [ ] 10-day review <br /> working days. See instructions for more information on this review process. [x]No review requested <br /> 8. HAVE YOU EVER APPLIED FOR AN ATC OR [X ]YES [ )NO Optional Section <br /> PTO IN THE PAST? If es,ATC/PTO#: I I.CHECK WHETHER YOU AREA <br /> Y PARTICIPANT IN EITHER OF <br /> !� 9. HAVE ALL NECESSARY LAND-USE f THESE VOLUNTARY PROGRAMS:11 AUTHORIZATIONS BEEN OBTAINED? [ J YES [X]NO ! "SPARE THE AIR" NO' <br /> !4 <br /> (If"No"is checked,please attach explanation) [ ]Yes [ ]NO [ ]Send info rel <br /> 10.IS THIS APPLICATION SUBMITTED AS THE I ]YES ]X ]NO "INSPECT" IN�p <br /> RESULT OF EITHER A NOTICE OF VIOLATION If yes,NOV/NTC#: j [ ]Yes [ )No [ ]Send info I <br /> OR A NOTICE TO COMPLY? <br /> 12. TYPE OR PRINT NAME OF APPLICANT: TITLE OF APPLICANT: <br /> JEFFREY C.HENLEY AGENT <br /> 13. SIGNATURE OF APPLICAN . DATE: PHONE#: (714)313-9140 <br /> FAX #: (562)924-9627 <br /> E-MAIL:JCHOLHOM@YAHOO.COM <br /> FOR APCD USE ONLY: <br /> DATE STAMP: FILING FEE <br /> RECEIVED: S CHECK#: <br /> DATE PAID: <br /> PROJECT#: FACILITY ID: <br /> Centref Revional Office; i 990 fast itciiVm.... <br />