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01/27/2010 18:12 FAX 230647 x]002/06)8 " <br /> San Joaquin Valley Air Pollution Control District ` <br /> www.valleyair.org <br /> Initial Permit Application for Farms <br /> I. PERMIT TO BE ISSUED TO(exactly as it should appear oat your Permit) <br /> 2. MAILING ADDRESS <br /> STREET/P.O.BOX: i e!r{- K Vie <br /> CITY: g_ SKATE: �� ZIP CODE: <br /> 3. LOCATION OF THE OPERATION <br /> 9 Z W. bio v1 F'le'e G <br /> 4.DATE OF INITIAL OPERATION: �-- <br /> 5. HAVE YOU EVER APPLIED FOR AN <br /> C 1'CS ❑NO Optional Section <br /> ATC PTO OR CMP PLAN IN THE PAST? If yes.ATC/PTO/CMP#: 8.CHECK WHETHER YOU <br /> G. HAVE ALL NECESSARY LAND-USEARE A PARTICIPANT IN <br /> AUTHORIZATIONS BEEN OBTAINED? YES NO EITHER OF THESE HEALTHY <br /> If"Yes"is chocked,please attach VOLUNTARY PROGRAMS: <br /> (!f"No"is checked,please attach copies of all land-use authorization) LIVING <br /> explanation) <br /> 7. IS THIS APPLICATION SUBMITTED AS "Healthy Air Living(HAL)" <br /> IF yes,NOV/PITC#: <br /> THE RESULT OF EITHER A NOTICE OF ❑ YLS QNO IDYes Q No n Send info del <br /> VIOLATION OR A NOTICE TO <br /> COMPLY? `.INSPECT" It'SP <br /> aE]Yes Q No El Send info <br /> EB&sedon <br /> CE CERTIFICATION <br /> ation and belief formed after reasonable inquiry,i,the responsible official,certify that all information and statements in <br /> plication package,including all accompanying reports,and required certifications are true,accurate,and complete. <br /> 9.NAME Or APPLICANT(if subject to Federal permits you must be the TITLE OF APPLICANT <br /> Responsible Official,see definition in tite instructions) <br /> �c(cvarr� F t7 <br /> -T-�I C0. �r• 0. pct� .1 rC <br /> I0.SIGNATURE OF APPLICANT(sign In irk) DATE CONTACT INFORMATION <br /> PHONE# <br /> FAX#: (�16 T')zS.l- '1 /I j <br /> EMAIL: <br /> t3ljl��ra-ioo�s� s be / <br /> FOR 9 ® a hle <br /> JUDATE STAMP FILING FEE <br /> L 2 2 2f 89 RECEIVED:$ <br /> CHECK a: l� <br /> SJVAPCD DATE PALO: <br /> NOIRIHERN REGI PROJECT 0:Al ! y <br /> FACILITY ID: J <br /> Northern Regional Office*4800 Enterprise Way*Modesto,California 95355-8718*(209)557-6400*FAX(209)557-6475 <br /> Central Regional Office* 1990 East Gettysburg Avenue*Fresno,California 93726-0244*(559)230-5900*FAX(559)230-6061 <br /> Southern Regional Office*34946 Flyover Court*Bakersfield,California 93308*(661)392-5500*FAX(661)392-5585 <br /> PA-0 <br /> Jan 2009 <br />