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t <br /> REQUEST FOR AUTHORIZATION OF <br /> SOIL AND/OR GROUNDWATER VAPOR EXTRACTION PILOT TESTS <br /> j 1. AUTHORIZATION TO BE GRANTED TO: <br /> ;,t) i2o, ) �v T W L /�C_t-1 <br /> 2. MAILING ADDRESS: <br /> Street/P.O.Box: 7, ] <br /> � 4G <br /> City: �'uv fi/GL � State: L-�✓1 Zip Code: y� <br /> 3. LOCATION WHERE THE PILOT TEST(S)WILL BE PERFORMED: <br /> Street: q f }'Yl (N S F <br /> City:_ CA <br /> it <br /> 4. APPROXIMATE START-UP DATE: <br /> 5. DURATION OF THE TESTS S A"Y1 �L 5 r'�t1 �' \ ` <br /> O: �i-, }{ (Specify Days or Hours) <br /> (Note:The proposal should be considered exempt from the District's permitting requirements if the test duration is five days or less) <br /> 6. CONTROL EQUIPMENT TO BE USED DURING PILOT TEST(S): <br /> [ j Carbon Canisters ( J Thermal/Catalytic Incinerators <br /> IC Engine ( ]Other(Specify): <br /> / \ (Additionally,please submit equipment specifications) <br /> 7. AIR FLOW CAPACITY OF THE EQUIPMENT (ACFM): /DO <br /> i <br /> 8. PRINT NAME OFAFPLICAPd'T:'^Pt1UL,` flSmS til- - .TITLES . .9. SIGNATURE SIGNATURE TELEPHONE NO: <br /> DATE: 2z&—VL / <br /> ' Please note that the regional Compliance Division,In which the pilot test is to be conducted, must be notified of equipment start-up <br /> date at least three days prior to the first day of testing. <br /> FOR APCD USE ONLY: <br /> DATE STAMP AUTHORIZATION DATE: <br /> I <br /> PROCESSED BY: <br /> 6 <br /> GEAR 14-4 <br />