DEQ-CFW_00087102

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Facility Name: J��6 VI t lA . ` P&V�G'�'�GV
1(/LG Region: -Application Number: 69 D 6669 , G �
Greenfield Facility: Yes 0 NoJB(. I YES
call region and fax them the Al Form to allow them to enter the facility into IMPAQ)'
'
Assign Application:.
PART I - ACCEPTANCE CHECKLIST (Determines Acknowledgement Letter Content)
Acknowledgement Letter: Already Sent
0 Please Send X-
Type Letter: Standard Renewal 0 Administrative Amendment 0 Ownership Change 0 Name Change 0
CC
n Fee Received O y� '
Yes No
Appropriate Number of Copies Received (minimum of 2) � 00
NA
8TV3 Small $50
Z'
Send Region Copy of Application' ,'
Ca
reen2 eld $8576
Consistency Determination Applied For 0
0
Synthetic Minor $400
Source Recycling/Reduction Form Received
Ownership Change $60
PE Seal C1
A
Renew"ame Change $0
Authorized Signature 0
0
PART II - IMPAQ UPDATES (Sets Schedules)
Permit Application Type
Processing Schedule
Additional Permit 0
Appeal 0 TV — Greenfield
C1
Administrative Amendment 0
Director Administrative Amendment 0 TV — Initial
0
Appeal, ' C1
Expedited State . 0 TV — Minor
Greenfield Facility 0
Permit Applicability Request 0 TV — Ownership Change
0
Modification
PSD 0 TV —Renewal
13
Name Change 0
Rescission 11 TV — Reopen for Cause
0
New Permit Ca
Revocation 0 TV — Significant
0
Ownership Change 0
• State 0 TV — Significant (2Q .0501(c)(2))
0
Renewal 0
Tax Certification 0 TV — State Only
0
Rescission Request 0
Title IV 0 TV — la Time,
0
Revocation 0
Transportation 0 'TV — 502(b)(10)
C7
Tax Certification 0
TV — Administrative 0 1120) Part I
CT
1120) Part I 0
TV — Expedited 0
PART III - COMPLETENESS CHECKLIST (For Engineers to Complete and Request Information If Necessary)
Required Application Forms Submitted and Completed 0 Modeling Protocol Acceptance
0
E5 Form (Significant Modifications)
C! Confmiation of Pollutants Modeled
0
Supporting -Materials & Calculations Received
0
PE Seal (If 15A NCAC 2Q .0112)
0
•
PART IV - GENERAL COMMENTS
/ YW,
hutact. G-IA Fi ` e Lm J-
NESHAP/MACT 0 PSD Avoidance
2Q .0711 0 Prohibitory Small
■
2D.11000
PSD 0
NSPS 0
Dates Issue Effective Expiration
IMPAQ Closed Out By: Permit Number._Revision Nu4w.
�CL
Permit Class Before After
Information (check all Small 0 Synthetic Minor 0 General 0 Small 0 Synthetic Minor 0 General 0
that apply) Prohibitory Small 0 Title i%,'R*"`Transportation 0 Prohibitory Small 0 Title VTransportation 0
HAP Major (10/25 tpy) % Major _ ,j Minor 0 Not Determined 0
PSD Status Major Min r
Miscellaneous Multiple Permits at Facility 0 Multi -Site Perrin tQuarry Special Permit 0 Recycled Oil Condition.0
Tracking Slip V24 - mjc
DEQ-CFW 00087102