The Utah 15C form is a crucial application used for obtaining a portable general permit from the Utah Division of Air Quality. This form ensures that all new equipment or modifications to existing operations comply with environmental regulations before they can be put into use. If you're ready to take the next step in your application process, fill out the form by clicking the button below.
The Utah 15C form serves as a crucial component in the process of obtaining a portable general permit for equipment operations within the state. This application is essential for companies seeking to ensure compliance with environmental regulations before commencing any construction or operation of equipment. It requires detailed information about the applicant's company, including contact details for both the business and the owner, as well as specifics regarding existing Approval Orders. The form also prompts applicants to identify the type of operation—whether it involves aggregate processing plants, asphalt plants, or concrete batch plants—and to disclose the number of employees at the facility. Furthermore, it addresses modifications to existing equipment and the need for new permits, emphasizing the importance of thorough and accurate information submission for an effective engineering review. Applicants are encouraged to reach out to the New Source Review Section of the Division of Air Quality for any questions, ensuring that all necessary documentation is completed accurately to facilitate a smooth approval process.
Utah Division of Air Quality
New Source Review Section
Form 15c
Portable General Permit Application
Date __________________________
Company ______________________
Site/Source_____________________
An Approval Order to construct must be approved before any equipment can be operated. Please refer to the Approval Order application instructions for specific details required to complete the application. Please print or type all information requested. All information requested herein must be completed and submitted before an engineering review can be completed. Please contact the New Source Review Section of the Division of Air Quality with any questions at (801) 536- 4000. Written inquiries may be addressed to: Division of Air Quality, New Source Review Section, P.O. Box 144820, Salt Lake City, Utah 84114-4820.
General Owner And Facility Information
1.
Company name and address:
2. Company contact for environmental issues:
Phone No.:
(
)
Phone No.: (
FAX No.:
FAX No.: (
E-mail address:
3.
Owners name and address:
Phone no.:
FAX no.:
4.
Identify any current Approval Order(s):
AO#_________________Date______________
5.
If request for modification, previous permit # and date:
DAQE-AN__________________
DATE: ____/____/____
6.
Type of operation:
Aggregate Processing Plants
Asphalt Plants
Concrete Batch Plants
7.
Total company employees greater
8. Standard Industrial Classification Code
than 100?
[ ] [ ] [
] [ ]
Yes
No
9.
Application for:
New equipment
Modification
Existing equipment operating without permit
10. For new equipment or modification, enter estimated start date:
11. For change of permittee, enter date
12. For existing equipment in operation without prior permit, enter initial operation
of occurrence:
date:
13. Has equipment been modified, moved or the capacity increased since November 29, 1969:
If yes: Specify what equipment:
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14.Equipment list (Table 1 and 2 Attach as Appendix A)
15.I hereby certify that the information and data submitted in and with this application is completely true, accurate and complete, based on reasonable inquiry and to the best of my knowledge and belief.
Signature:
16.
________________________
Name (Typed or printed)
Title:
17.Telephone Number: ( )
18. Date:
General Permit Application
Instructions
1.Identify the name, address, phone number, and fax number of the legal entity that operates the equipment.
2.Identify the person who is to be contacted regarding this application; also include the phone number and fax number of this person.
3.If you are not the owner of the equipment under this application, enter the name, address, phone number, and fax number of the owner.
4.List any valid Approval Orders (AO) which are for equipment at this site.
5.Indicate previous AO number (if any) and date for AO modification.
6.State the type of operation.
7.Indicate if the total number of people employed by your company is over 100 people.
8.Using the provided list of business codes (page 8), enter the code which best describes your business activity at this facility.
9.Check all applicable boxes
Existing Equipment Operating Without permit - equipment which has been in operation without a prior permit issued by the state.
Modification - existing equipment which is physically altered by the removal, addition, or non-identical replacement of parts.
10.Enter the start date new equipment or modification.
11.For cases in this category, enter the future date when the change is anticipated.
12.For this category of equipment, enter the date when this equipment was first operated.
13.This is for equipment that was operated before November 29, 1969. Indicate whether equipment has been moved, modified or increased capacity since that date. Specify what equipment this includes.
14.Attach as Table 1 and 2 to the application a list of all portable equipment (NSPS/MACT - Table 1 and Non-NSPS - Table 2) that is owned or operated by the company. Forms are available from DAQ for these two tables.
15.Signature of authorized company agent.
16.Name of signing party.
17.Telephone number of signing party.
18.Date of application.
Additional information may be required for some projects. If so, the reviewing engineer will contact the individual listed in question number 2.
f:\aq\engineer\generic\Forms 2010\Form15c Portable Generic Permit Application.doc Revised 12/20/10
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