DEQ-CFW_00086882

CENTRAL OFFICE PERMIT TRACKING SLIP
Facility Name
' �n-� �g .�/�t �'v��- Region: G Application Number: O `� D 6bo 7 : v 7A
County0 Greenfield Facility: Yes U No)( (If YES, call region/fax Al Form for entry into IBEAM)
Assigfl Application: Pa-t5evt-�d✓1
PART I - ACCEPTANCE CHECKLIST (Determines Acknowledgement Letter Content)
Acknowledgement Letter: Already Sent 0 Please Send A
'Type Letter: Standard —p� Renewal ❑ Administrative Amendment ❑ Ownership Change ❑ Name Change 0
Application Not Accepted (Incomplete) ❑ (This event stops the clock until needed material is received and event is closed out in [BEAM)
Application Fee Received ib 1.
� Yes No NA
PSD or NSR/NAA $13,488 Appropriate Number of Copies Received (minimum of 2) A ❑ ❑
PSD and NSR/NAA $26,235 Send Region Copy of Application 0 0
TV Greenfield $8,910 Consistency Determination Applied For
El
Source Recycling/Reduction Form Received 0 0
TV $86 ❑ ❑ %
ership Change $62 PE Seal ❑ ❑
Renewal/Name Change — Not Applicable Authorized Signature
PART II - IBEAM UPDATES (Sets Schedules)
Permit Application Type Processing Schedule
Additional Permit 0 Appeal ❑ TV — Administrative ❑
Administrative Amendment Cl Director Administrative Amendment ❑ TV — Expedited ❑
Appeal ❑ Expedited State ❑ TV — Greenfield Cl
Greenfield Facility ❑ Permit Applicability Request ❑ TV — Minor ❑
Last MACT/Air Toxics 0 PSD ❑ TV — Ownership Change ❑
State 0 TV — Renewal 0
Modification X
Name Change ❑ TV — Reopen for Cause ❑
Permit
❑ TV — Significant ❑
New TV — Significant (2Q .0501(c)(2)) 0
Ownership Change ❑
❑
TV — State Only
Renewal ❑
Renewal w/Modification ❑ TV — 502(b)(10)
TV —1 a Time o
PART III - COMPLETENESS CHECKLIST (For Engineers to Complete and Request Information if Necessary)
Required Application Forms Submitted and Completed ❑ PE Seal (If 15A NCAC 2Q .0112) ❑
Modeling Protocol Acceptance D
ES Form (Significant Modifications) ❑
Supporting Materials & Calculations Received ❑ Confirmation of Pollutants Modeled D
PART IV - GENERAL COMMENTS
}2� S� �'Cu vt. ►S i ci2 113 e� —y e ri rV_e s
H7/r2(�L4 /lout `h.4 u1 1 %//a✓� f•ic 1s�r^�i+-v a"itr+�iYM/�i=* l '1/1 'vlil�l l/ /�Gt�Z✓ LbdV`Gt�� --
PART V - SUPERVISOR VIEW CHECKLIST
P
ESM Updated by Engineer, R14 TV Coordinator: 101q.01 c�
SupervisorA�� � 2®®� C
ESM Verified:
PART VI - CLOSEOUT INFORMATION
Regulations Applicable to This Application (indicate all new regulations) ISRS
0 NESHAP/MACT voidance ❑ 2D .1100 _
❑ 2Q .05'ia�st
❑ Prohibito a ❑SIP 1\. y
❑ 2Q .0MA oxic After
Before
Permit Class Information Small 0 Synthetic Minor ❑ General ❑ Small ❑ Synthetic Minor ❑ General ❑
(check all that apply) Prohibitory Small 0 Title VXTransportation ❑ Prohibitory Small ❑ Title V�'Iransportation ❑
IIAP Major (10/25 tp) Majo Minor ❑ Not Determined ❑
PSD Status Major inor ❑
Miscellaneous Multiple Permits at Facility ❑ / Multi -Site Permit 0 Quarry Special Permit ❑ Recycled Oil Condition [I
Dates Issue Effective Expiration �l c3 ]
IBEAM Closed Out By:
Permit Nu ber: 1 Revision Number: /
to
Document Manager Updated by Engineer: f i
Tracking Slip V30 - rnic
DEQ-CFW 00086882