Laserfiche WebLink
San Joaq uiAalle lotion o�rol District <br /> Y Air Pollution C, <br /> www.valleyair.org <br /> Permit Application For: <br /> j ] AUTHORITY TO CONSTRUCT(ATC) -New Emission Unit <br /> [ ] 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 /> i <br /> 1. PERMIT TO BE ISSUED TO: <br /> I ARCO#2075 <br /> if <br /> 2. MAILING ADDRESS: jj <br /> STREET/P.O.BOX: 800E.Kettleman Rd. l <br /> 9-DIGIT <br /> 1 CITY: Lodi --_-._- _.— STATE: CA ZIP CODE: �1 <br /> i, <br /> 3. LOCATION WHERE THE EQUIPMENT WILL BE OPERATED: WITHIN 1,000 FT OF A <br /> ii <br /> II STREET: 800 E Kettleman Rd. CITY. LAM SCHOOL? [ ]YES [X]NO 11 <br /> ii S.I.C.CODE(S)OF FACILITY li <br /> II /4 SECTION TOWNSHIP RANGE (If known): I' <br /> I <br /> 4. GENERAL NATURE OF BUSINESS:Retail Gas Station INSTALL DATE: <br /> �I S. TITLE V PERMIT HOLDERS ONLY: Do you request a COC(EPA Review)prior to receiving your ATC(/fres, [ ]YES [ )NO �! <br /> please complete and attach a Compliance Certification form(TVFORM-009)? <br /> 5. DESCRIPTION OF EQUIPMENT OR MODIFICATION FOR WHICH APPLICATION IS MADE(include Permit#'s if known,and use 1 <br /> additional sheets if necessary) <br /> Replace 4"diameter steel risers @ Flls and VRs to meet proper install height. Replace drop tube gaskets. <br /> 7. PERMIT REVIEW PERIOD: Do you request a three-or ten-day period to review the draft Authority to Construct [ j 3-day review <br /> permit?Please note that checking"YES"will delay issuance of your final permit by a corresponding number of [ 110-day review <br /> working days. See instructions for more information on this review process. [xJ No review requested <br /> 8. HAVE YOU EVER APPLIED FOR AN ATC OR [X ]YES [ )NO Optional Section <br /> PTO IN THE PAST? ,I I.CHECK WHETHER YOU AREA I' <br /> II If yes,ATC/PTO#: I PARTICIPANT IN EITHER OF Z <br /> 1 9. HAVE ALL NECESSARY LAND-USE I THESE VOLUNTARY PROGRAMS: <br /> �i AUTHORIZATIONS BEEN OBTAINED? [ ]YES [X )NO "SPARE THE AIR" <br /> iR <br /> (If"No"is checked,please attach explanation) ; [ ]Yes [ ]No [ ]Send info A <br /> it 10.IS THIS APPLICATION SUBMITTED AS THE [ ]YES [X ]NO I "INSPECT <br /> �I RESULT OF EITHER A NOTICE OF VIOLATION [ ]No [ info <br /> Yes i { <br /> .j If yes,NOV/NTC#: [ ] ]Send i <br /> OR A NOTICE TO COMPLY? <br /> 112. TYPE OR PRINT NAME OF APPLICANT: TITLE OF APPLICANT: !I <br /> JEFFREY C.HENLEY AGENT �I <br /> " 13. SIGNATURE OF APPLICANT' DATE: PHONE#: (714)313-9140 <br /> FAX #: (552)924-9627 <br /> i / ! E-MAIL:JCHOLHOM@YAHOO.COM <br /> FOR APCD USE ONI L1'_ <br /> DATE STAMP: FILING FEE <br /> RECEIVED: $ CHECK#: <br /> DATE PAID: <br /> di f PROJECT#: FACILITY ID: <br /> I I II <br />