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v <br />San Joaquin Pollution ! <br />org <br />Permit Application For: <br />AUTHORITY TO CONSTRUCT (ATC) - New Emission Unit. <br />It 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 />M PERMIT TO OPERATE (PTO) - Existing Emission Unit Now Requiring a Permit to Operate. <br />1. PERMIT TO BA ISS TO: la b <br />2. MAILING ADDRESS: <br />S 0 <br />STREET/P.O. BOX: <br />9 -DIGIT <br />CITY:O STATE: ZIP CODE: y� <br />3. LOCATION WHERE 3;;=E R�AT�E: ��q�/�WMUN <br />Z �� 2, S�O G I �-1 w 1 <br />1,000 FT OF A <br />SCHOOL? YES IMNO <br />STREET: �`� CrrY: <br />SIC. CODE(S) OF FACILITY <br />/4 SECTION TOWNSHIP RANGE <br />(Ifknown): <br />4. GENERAL NATURE OF BUSINESS: o <br />INT ATE: <br />5. TITLE V PERMIT HOLDERS ONLY: Do you request a COC 06A Review r to receiving your ATC? YES NO <br />6. DESCRIPTION OF EQUIPMENT OR MODIFICATION FOR WHICH APPLICATION IS MADE (include Permit Ns if known, and use <br />additional sheets if necessary) ,,r- 4fte, us rs W,' <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 da . See instructions for more information on this review rocess.o review r nested <br />8. HAVE YOU EVER APPLIED FOR AN ATC OR YES NO <br />Optional Section <br />PTO IN THE PAST? If es, ATC/PTO #: <br />Y <br />11. CHECK � YOU ARE A <br />PARTICIPANT IN EITHER OF <br />9. HAVE ALL NECESSARY' LAND -USE <br />AUTHORIZATIONS BEEN OBTAINED? YES NO <br />THESE VOLUNTARY PROGRAMS: <br />"SPARE THE AIR" PAIR <br />Cff "No" is checked, please attach explanation.) <br />es ONo Uend info <br />10. IS THIS APPLICATION SUBMITTED AS THE YES Eg NO <br />"INSPECT" <br />RESULT OF EITHER A NOTICE OF VIOLATION If yes, NOV/NTC #: <br />DYes o r3Send info <br />OR A NOTICE TO COMPLY? <br />12. TYPE OR PRINT NAME OF PLICANT: ) ��{ <br />TIME OF APPLIC <br />ZA 1, / G,�'v <br />Y G�lr'' <br />13. SIGN TURE OF AP LICANT: DATE: <br />PHONE #: Uo <br />( ) <br />FAX #:ffA�f <br />Z/--� I <br />E-MAIL: <br />FOR APCD USE ONLY: v v <br />nj'1yy4intr QMW6m& <br />FILING FEE <br />RECEIVED: S CHECK #: <br />DATE PAID: <br />PROJECT #: <br />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 />aw: oa 2M <br />