AQ_F_0800044_20050202_EI_Fac-EI-Rpt

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Inventory Certification Form(Title V) W
Facility Name: Avoca Incorporated Facility ID : 0800044
State Road 1502 Permit : 01819
Merry Hill,NC 27957 County : Bertie
DAQ Region : WARO
North Carolina Department of Environment and Natural Resources
Division of Air Quality
Air Pollutant Point Source Emissions Inventory—Calendar Year 2004
These forms must be completed and returned even if the facility did not operate or emissions were zero
The legally defined "Responsible Official" of record for your facility is David Peele
This person or one that meets the definition below must sign this certification form.
The official submitting the information must certify that he/she complies with the requirements as specified in Title 15A
NCAC 2Q.0520(b)which references and follows the federal definition.40 CFR Part 70.2 defines a responsible as meaning one
of the following:
1. For a corporation: a president,secretary,treasurer,or vice—president of the corporation in charge of a principal
business function, or any other person who performs similar policy or decision making functions for the overall
operation of one or more manufacturing,production,or operating facilities applying for a or subject to a permit and
either
i. the facilities employ more than 250 persons or have gross annual sales or expenditures exceeding$25
million(in second quarter 1980 dollars);or
ii. the delegation of authority to such representatives is approved in advance by the permitting authority;
2. For partnership or sole propietorship;a general partner or the proprietor,respectively;
3. for a muncipality, state,federal,or other public agency includes the chief executive officer having responsibility for the
overall operations of a principal geographic unit of the agency(e.g., a Regional Administrator of EPA).
CERTIFICATION STATEMENT:
Im rt t: Legally RoMgnsible Official.read andsign after all submissions are1.
certify that I am the responsible official for this facility, as described above, and hereby certify that the information contained
in this air emissions report,including attached calculations and documentation,is true, accurate and complete. (Subject to legal
enalities of up to$10,000 per occurrence and possible imprisonment as outlined in G.S.§143-215.3(a)(2))
Responsible Official's Signature Below (use blue ink): Date Sicned:
Printed Name: David Pe
,Signature:
This form applies to Title V facilities. If this facility is not classified as Title V,please telephone your regional office Emission
Inventory contact at once for proper forms.
Email address of Responsible Official:
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i
i
lI FEB 2 20,u�
Information on this Form cannot be held confiden al
DAO VVARO
1

�r0
Inventory Certification Form(Title V) W
Facility Name: Avoca Incorporated Facility ID : 0800044
State Road 1502 Permit : 01819
Merry Hill,NC 27957 County : Bertie
DAQ Region : WARO
North Carolina Department of Environment and Natural Resources
Division of Air Quality
Air Pollutant Point Source Emissions Inventory—Calendar Year 2004
These forms must be completed and returned even if the facility did not operate or emissions were zero
The legally defined "Responsible Official" of record for your facility is David Peele
This person or one that meets the definition below must sign this certification form.
The official submitting the information must certify that he/she complies with the requirements as specified in Title 15A
NCAC 2Q.0520(b)which references and follows the federal definition.40 CFR Part 70.2 defines a responsible as meaning one
of the following:
1. For a corporation: a president,secretary,treasurer,or vice—president of the corporation in charge of a principal
business function, or any other person who performs similar policy or decision making functions for the overall
operation of one or more manufacturing,production,or operating facilities applying for a or subject to a permit and
either
i. the facilities employ more than 250 persons or have gross annual sales or expenditures exceeding$25
million(in second quarter 1980 dollars);or
ii. the delegation of authority to such representatives is approved in advance by the permitting authority;
2. For partnership or sole propietorship;a general partner or the proprietor,respectively;
3. for a muncipality, state,federal,or other public agency includes the chief executive officer having responsibility for the
overall operations of a principal geographic unit of the agency(e.g., a Regional Administrator of EPA).
CERTIFICATION STATEMENT:
Im rt t: Legally RoMgnsible Official.read andsign after all submissions are1.
certify that I am the responsible official for this facility, as described above, and hereby certify that the information contained
in this air emissions report,including attached calculations and documentation,is true, accurate and complete. (Subject to legal
enalities of up to$10,000 per occurrence and possible imprisonment as outlined in G.S.§143-215.3(a)(2))
Responsible Official's Signature Below (use blue ink): Date Sicned:
Printed Name: David Pe
,Signature:
This form applies to Title V facilities. If this facility is not classified as Title V,please telephone your regional office Emission
Inventory contact at once for proper forms.
Email address of Responsible Official:
� r
i
i
lI FEB 2 20,u�
Information on this Form cannot be held confiden al
DAO VVARO
1