1. General: (a) Consent is issued to: .........................................………………………………… (Corporation, Company, Government Agency, Firm etc.) (b) Postal Address: ....................................................................................... ………………………………………………………………………………. II. Location of plant or facilities: (Latitude and longitude must be to the nearest of 15 seconds) (a) Nearest City…………………………… District ……………………………….. (b) Latitude………………………………… Longitude…………………………… (c) Is it located in air pollution control area - Yes/No. If yes, Identification of air pollution controls area. III. Type of operation or process : (a) Name of operation or process (b) Schedule identification number IV. Consent classification Yes No (a) Proposed ¬¬¬¬_______ _______ (b) Now operating _______ _______ (c) Modification of existing emission source. _______ _______ (d) Location change _______ _______ (e) Ownership change _______ _______ (f) Present-consent order Number if any…………………………………………… V. Implementation Dates: (a) In the case of proposed industries Operation expected to begin ______ _______ ______ (Day) (Month) (Year) (b) Air pollution control equipment and Emission to be installed standards Achieved by ______ _______ ______ (Day) (Month) (Year) VI. Emission Standards: Emission source Number (from plot plan) Air Pollutant emitted. Emission rate kg/hour of standard/see 1 2 3 VII. Consent conditions if any:
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