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San Joaquin Valley Air Pollution Control District <br /> www.valleyair.org <br /> Permit Application For: <br /> (d] 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 /> [ 1 PERMIT TO OPERATE TO - ExistingEmission Unit Now Requiring a Permit to Operate. <br /> ij (PTO) <br /> F3, <br /> ERMIT TO BE ISSUED TO: USA Gasoline Corporation <br /> AILING ADDRESS: 3330 Cameron Park Drive, Suite 550 <br /> STREET/P.O"BOX: 96fi$Z <br /> - ..s-nlcrr <br /> cgy- Cameron Park STATt: CA ztiP CODE: <br /> OCATION WHERE THE EQUIPMENT WILL BE OPERATED: WITHIN 1,000 FT OF A <br /> TREET: 2500 West Lodi Avenue CITY: nodi scxooL? [ ] YES [✓]NO <br /> S.I.C. CODE(S) OF FACILITY <br /> /4 SECTION TOWNSHIP RANGE <br /> iY (If known): <br /> 4. GENERAL NATURE OF BUSINESS:Retail Gas Station INSTALL DATE: <br /> 5. TITLE V PERMIT HOLDERS Do you request a COC'(EPA Review) prior to receiving your ATC? - [ ] YES [ ] NO <br /> J. <br /> ONLY: <br /> S. DESCRIPTION OF EQUIPMENT OR MODIFICATION FOR WHICH APPLICATION IS MADE (include Permit C's if known, and use <br /> additional sheets if necessary):: ; <br /> Soil vapor extraction consisting of 5 hp roots positive displacement blower and USFilter's Vent Scrub <br /> adsorption vessel with 1,000 pounds of granular activated carbon <br /> I <br /> 1 <br /> 7. HAVE YOU EVER APPLIED FOR AN ATG OR [✓] YES { ]'NO :j Optional Section <br /> PTO IN THE PAST? to CHECK WHETHER YOU ARE A PAI <br /> / <br /> If yes,ATC/PTO#:N-903-2-3 I PARTICIPANT IN EITHER OF <br /> 1, IS THIS PROPERTY ZONED PROPERLY FOR S THESE VOLUNTARY PROGRAMS: <br /> THE PROPOSED USE? [`/] YES [ ] NO SPARyE THE AIR" <br /> [ ]Yes [J]NO [ ]Send info <br /> 9. IS THIS APPLICATION SUBMITTED AS THE "INSPECT' `ly4P <br /> RESULT OF EITHER A NOTICE OF [ ] YES [✓]NO <br /> ] VIOLATION OR A NOTICE TO COMPLY? If yes,NOV/NTC.#: ]Yes [, No [ ]Send info <br /> 'ii <br /> I1. TYPE OR PRINT NAME OF APPLICANT: TITLE OF APPLICANT: <br /> Gowri S. Kowtha, P. E. Project Manager <br /> 12. SIGNATURE OF APPLICANT: , DATE: PHONE#: 530.676.6001 <br /> FAX #: 530.676.6005 <br /> E-MAIL: akowtha(a)stratusinc.net <br /> FOR APCD USE ONLY: <br /> DATE STAMP FILING FEE <br /> RECEIVED: $ CHECK#: <br /> i <br /> ' I1. <br /> DATE PAID: <br /> s <br /> 1 t PROJECT#: ; FACILITY ID: <br /> Northern Regional Office*4230 Kiernan Avenue, Suite 130* Modesto, California 95356-9321 * (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 *2700 M Street; Suite 275 * Bakersfield, California .93301-2370* (661) 326-6900 *FAX (661) 326-6985 <br /> RN'.IedY 26tlE1 i <br />