AQ_F_0800081_20120125_CMPL_GenNot

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NESHAP for Reciprocating Internal Combusti n E � (RI ) Subpart ZZZZ)
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State of North Caroli
NOTIFICATION FORM
FACILITY INFORMATION:
Facility Name: tj' Z 1Lg FARrns;Znc,
Facility ID: D8 ofI D;?/ p
Facility Owner/Operator: /El4 UE FA4zm �,
Facility Address:
17i!? 1WAV 30? WF.Sf
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APPLICABLE STANDARD: Reciprocating Internal Combustion Engines(RICE)
(NESHAP Subpart ZZZZ)
Facility Compliance Date: July 1,2008 (existing sources) OR upon startup (new sources)
Is your facility a major source of HAPs? (check one)
❑ Yes. My facility is a major source of HAPs.
U1, No. My facility is an area source of HAPs
Note:A major source is a facility that emits or had the potential to emit greater than 10 tons per year of any
one HAP or 25 tons per year of multiple HAPs.All other sources are area sources.
Is your facility subject to Subpart ZZZZ? (check one)
U" I am unsure of my status and would like additional information
❑ Yes
❑ No (Please explain)
SOURCE DESCRIPTION
Briefly describe the source. section 63.9 b 2 iv
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SIGNATURE
Signature of Responsible Person or Company Official:
f/ DDate: n
(Print): l�l/t�c�n� I � �it R IE�i�E M !ndxl �r�vR DnfnFn"fRL
Title:
Return this form to:
Patrick Knowlson
NC Division of Air Quality
1641 Mail Service Center
Raleigh, NC 27699-1641
If you have questions about this form, please_ contact Patrick Knowlson via phone at(919)715-0659 or via e-mail at
[e-mail]
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