CLASS II GENERAL AIR QUALITY OPERATING PERMIT FOR TEMPORARY CONSTRUCTION SOURCES CHANGE OF LOCATION APPROVAL COMPLETION OF OPERATIONS REPORTING FORM Completing this form will comply with the reporting requirements of the Nevada Division of Environmental Protection Bureau of Air – Pollution Control Class II General Air Quality Operating Permit For Temporary Construction Sources Change of Location Approval. Under the authority of NAC 445B.250 and NAC 445B.315(3)(h) the owner or operator shall notify the Director of the actual production and hours of operation within 30 days of the completion of the job. Failure to provide the required production report(s) shall result in disapproval of future change of location requests until the report(s) are received, and may subject the holder of the operating permit to a Notice of Alleged Violation in accordance with NAC 445B.275. Company Name Facility ID Number (A####) Permit Number (AP####-####.04) COLA Number County Where COLA is Located Total System or Operating System/Unit Description Throughput Throughput Unit # Hours (i.e. Crushing and Screening, Hopper Rate at this Actual Completion Date (i.e. Loading, Lime Marination Plant) (tons/hr) Location PF1.001) hrs/day Total hrs (tons/job) I certify that the information contained in this form is true, accurate and complete. Signature of Responsible Official Print or Type Name and Title
CLASS II GENERAL AIR QUALITY OPERATING PERMIT FOR TEMPORARY CONSTRUCTION SOURCES CHANGE OF LOCATION APPROVAL COMPLETION OF OPERATIONS REPORTING FORM Completing this form will comply with the reporting requirements of the Nevada Division of Environmental Protection – Bureau of Air Pollution Control Class II General Air Quality Operating Permit For Temporary Construction Sources Change of Location Approval. Under the authority of NAC 445B.250 and NAC 445B.315(3)(h) the owner or operator shall notify the Director of the actual production and hours of operation within 30 days of the completion of the job. Failure to provide the required production report(s) shall result in disapproval of future change of location requests until the report(s) are received, and may subject the holder of the operating permit to a Notice of Alleged Violation in accordance with NAC 445B.275. Company Name Facility ID Number (A####) Permit Number (AP####-####.04) COLA Number County Where COLA is Located System or Unit # (i.e. PF1.001) System/Unit Description (i.e. Crushing and Screening, Hopper Loading, Lime Marination Plant) Throughput Rate (tons/hr) Total Throughput at this Location (tons/job) Operating Hours hrs/day Total hrs Actual Completion Date I certify that the information contained in this form is true, accurate and complete. Signature of Responsible Official Print or Type Name and Title
170810-cola-completion-form.docx