DEQ-CFW_00085848

CENTRAL OFFICE PERMIT TRACKING SLIP
Facility Name: i ( \: L' Facility ID: L , C"U 111c [ County:
Regional Office: )-ram ; Application ID: Engineer: F'c v:q
Send Regional Office Copy of Application: C Yes XfNo
PART I - ACCEPTANCE CHECKLIST
Acknowledgement Letter: ❑ Already Sent ,,Please Send
Initial Event(s): �, TV-Acknowledgement/Complete ❑ TV-Acknowledgement/Incomplete add info
❑ Acknowledgement Letter due ❑ Application not accepted - add info request
Fee Information:
Acceptance Check List:
Amount Due: PSD or NSR/NAA $13,488
Yes
No NA
PSD and NSR/NAA $26,235
Appropriate Number of Apps Submitted (minimum of 2)
';8L
❑ ❑
TV Greenfield $8,910
Application Fee Submitted
TV $867
ip Change
Zoning Addressed
❑ C'
ivrrers $62
Source Recycling/Reduction Form Submitted
'x
Renewal/Name Change - NA
Authorized Signatures,
Initial Amount Received: �. t
PE Seal
❑
❑
Additional Amount Due: NA
PART II - IBEAM UPDATES
PART III - COMPLETENESS CHECKLIST
Application Type:
Permit Application Schedule:
❑ Additional Permit
❑ Appeal C Director Administrative Amendment
❑ Required Application Forms Submitted and Completed
❑ Administrative Amendment
❑ Expedited State L. Permit Applicability Request
❑ Supporting Materials & Calculations Received
❑Appeal
❑ PSD a State
❑ PE Seal (If 15A NCAC 2Q .0112)
❑ Greenfield Facility
❑ Modeling Protocol Acceptance
❑ Last GACT/Toxics
❑ TV — State Only D TV — Minor
D Confirmation of Pollutants Modeled
❑ Last MACT/Toxics
❑ TV — I" Time ❑ TV — Ownership Change
❑ E5 Form (Significant Modifications)
X.Modification
❑ TV — 502(b)(10) ❑ TV — Renewal
❑ Name Change
❑ TV — Administrative U, TV — Reopen for Cause —j
❑ New Permit
❑ TV — Expedited f�<TV — Significant (2Q .0501(c)(2))
❑ Ownership Change
❑ TV — Greenfield ❑ TV — Significant
D Renewal
❑ Renewal w/Modification
{ , ,,,{PART I`' - GENERAL COMMENTS
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PART V - SUPERVISOR REVIEW CHECKLIST
t
ESM Updated (by Engineer):, l € ESM Verified �'' !� ° (��� Supervisor:
PART VI - CLOSEOUT INFORMATION /
Regulations Applicable to This Application (indicate all new regulations): / / Permit Class Information
❑ NESHAPS/MACT ❑ PSD Before After
❑ NESHAPS/GACT PSD Avoidance %` ❑ Small
E, ;`Title V
[ LNSPS (,' - ❑ Existing Source RACT/LAER ❑ Syn Minor
❑ 2D .1100 ❑ New Source RACT/LAER vTitle V
❑ 2Q .0711 ❑ RACT/LAER Added Fee ❑ Proh Small
❑ 2Q .0705 Last MACT/Toxics D General
Transportation
HAP Major (10/25 tpy) Major ❑ Minor ❑ Not Determined
PSD Status TsI ajor D Minor
Miscellaneous C Multiple Nimits at Facility ❑ Multi -Site Permit ❑ Recycled Oil Condition
Dates Issue t 15 Effective 1 % 6 r 4tO�Cp Expiration ® 7; r ff
IBEAM Closed Out By: Permit Number:; Revision Number:
f
❑ Public Notice Published ) ❑ Public Notice Affidavit g J 1A
Document Manager Updated by Engineer: Date:
Tracking Slip V32 - mjc
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DEQ-CFW 00085848