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San Y <br />Joaq uin*alle Air Pollution Collrol District <br />www.valleyair.org <br />Permit Application For; <br />[ ] 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 />1. PERMIT TO BE ISSUED TO: <br />ARCO # 6347 <br />2. MAILING ADDRESS: <br />STREET/P.O. BOX: 2430.14)e Pombo P"Y. <br />CITY: <br />9 -DIGIT <br />STATE: CA ZIP CODE: <br />3. LOCATION WHERE THE EQUIPMENT WILL BE OPERATED: <br />STREET: 2430 Joe Pomba Pkwy., CITY: Tracy <br />i4 SECTION TOWNSHIP RANGE <br />4. GENERAL NATURE OF BUSINESS: Retail Gas Station <br />WITHIN 1,000 FT OF A <br />SCHOOL? [ ] YES [X ] NO <br />S.I.C. CODE(S) OF FACILITY <br />(Ifknown): <br />INSTALL DATE: <br />5. TITLE V PERMIT HOLDERS ONLY: Do you request a COC (EPA Review) prior to receiving your ATC (If yes. [ ] YES [ ] NO <br />please complete and attach a Compliance Certification form (DIFORM-009)? <br />6. DESCRIPTION OF EQUIPMENT OR MODIFICATION FOR WHICH APPLICATION IS MADE (include Permit #'s if known, and use <br />additional sheets if necessary) <br />Replace 4" diameter steel risers C&_ Fils and VRs to meet proper install height. <br />fi <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 [ J 10 -day review <br />working days. See instructions for more information on this review process. [ x No review requested <br />8. HAVE YOU EVER APPLIED FOR AN ATC OR [X ] YES [ ] NO Optional Section <br />I I . CHECK WHETHER YOU ARE A <br />PTO IN THE PAST? <br />If yes, ATC/PTO #: PARTICIPANT IN EITHER OF -- <br />i <br />�} 9. HAVE ALL NECESSARY LAND -USE THESE VOLUNTARY PROGRAMS: \ ij <br />II AUTHORIZATIONS BEEN OBTAINED? { ] YES [ X ] NO 1 "SPARE THE AIR" R it <br />(If"No" is checked, please attach explanation) j ]Yes [ ]No [ ]Send info i l <br />II 14. IS THIS APPLICATION SUBMITTED AS THE "INSPECT' to <br />II [ ]YES IX ] NO j alN,/ N <br />II RESULT OF EITHER A NOTICE OF VIOLATIONIf yes [ ]Yes { ]No I ]Send info V <br />, NOV/NTC #: 1� <br />ll OR A NOTICE TO COMPLY? I <br />12. TYPE, OR PRINT NAME OF APPLICANT: <br />JEFFREY C. HENLEY <br />TITLE OF APPLICANT; <br />AGENT <br />Il 13. SIGNATURE OF APPLIC DATE: j PHONE #: (714) 313-9140 II <br />II FAX #: ( 562) 924-9627 <br />i E-MAIL: JCHOLHOMra YAHOO.COM <br />FOR APCD USE ONLY: <br />DATE STAMP: FILING FEE <br />RECEIVED: S CHECK <br />DATE PAID: <br />PROJECT #: FACILITY ID:j <br />i <br />