5. Owner/Authorized Representative Statement: I, the undersigned, am the owner or authorized representative of the corporation, partnership, or other legal entity submitting this air permit application. To the best of my knowledge, the statements made in this application are true, accurate and complete, and any estimates of emissions reported in this application are based upon reasonable techniques for calculating emissions. I understand that a permit, if granted by the department, cannot be transferred without authorization from the department. ___________________________________________ ________________________ Signature Date Application Responsible Official Certification Complete if applying for an initial, revised, or renewal Title V air operation permit or concurrent processing of an air construction permit and revised or renewal Title V air operation permit. If there are multiple responsible officials, the responsible “application official” need not be the responsible official.” “primary 1. Application Responsible Official Name: 2. Application Responsible Official Qualification one or more of the following options, as applicable): For a corporation, the president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy or making functions for the corporation, or a duly authorized representative of such person if the representative is responsible for the overall operation of one or more manufacturing, production, or operating facilities applying for or subject to a permit under Chapter 62-213, F.A.C. For a partnership or sole proprietorship, a general partner or the proprietor, respectively. For a municipality, county, state, federal, or other public agency, either a principal executive officer or ranking elected official. The designated representative at an Acid Rain source or CAIR source. 3. Application Responsible Official Mailing Address... Organization/Firm: Street Address: City: State: Zip Code: 4. Application Responsible Official Telephone Numbers... Telephone: (____) ____ - _________ ext._________ Fax: (____) - ________ 5. Application Responsible Official E-mail Address:
5. Owner/Authorized Representative Statement: I, the undersigned, am the owner or authorized representative of the corporation, partnership, or other legal entity submitting this air permit application. To the best of my knowledge, the statements made in this application are true, accurate and complete, and any estimates of emissions reported in this application are based upon reasonable techniques for calculating emissions. I understand that a permit, if granted by the department, cannot be transferred without authorization from the department. ___________________________________________ ________________________ Signature Date Application Responsible Official Certification Complete if applying for an initial, revised, or renewal Title V air operation permit or concurrent processing of an air construction permit and revised or renewal Title V air operation permit. If there are multiple responsible officials, the “application responsible official” need not be the “primary responsible official.” 1. Application Responsible Official Name: 2. Application Responsible Official Qualification one or more of the following options, as applicable): For a corporation, the president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy or functions for the corporation, or a duly authorized representative of such person if the representative is responsible for the overall operation of one or more manufacturing, production, or operating facilities applying for or subject to a permit under Chapter 62-213, F.A.C. For a partnership or sole proprietorship, a general partner or the proprietor, respectively. For a municipality, county, state, federal, or other public agency, either a principal executive officer or ranking elected official. The designated representative at an Acid Rain source or CAIR source. 3. Application Responsible Official Mailing Address... Organization/Firm: Street Address: City: State: Zip Code: 4. Application Responsible Official Telephone Numbers... Telephone: (____) ____ - _________ ext._________ Fax: (____) - ________ 5. Application Responsible Official E-mail Address: making