HomeMy WebLinkAbout6.06 CDPHE General Permit ApplicationCOLORADO
Form APCD-100 Department of Public
A& Ift Health & Environment
Oil & Gas Industry
Construction Permit Application Completeness Checklist
Ver. November 29, 2012
Company Name: Caerus Piceance, LLC
Source Name:
Date:
N23 496 CDP
January 2022
Yes No
Are you requesting a facility wide permit for multiple emissions points? r-I 21
In order to have a complete application, the following attachments must be provided, unless stated
otherwise. If gpplication is incomplete, it will be returned to sender and filing fees will not be refunded.
Attachment
Application Element
Applicant
APCD
A
APEN Filing Fees
El
B
Air Pollutant Emission Notice(s) (APENs) &
M
M-
Application(s) for Construction Permit(s) — APCD Form Series 200
C
Emissions Calculations and Supporting Documentation
E]
0
D
Company Contact Information - Form APCD-101
El
0
E
Ambient Air Impact Analysis
Q
M
E] Check here if source emits only VOC (Attachment E not required)
F
Facility Emissions Inventory — Form APCD-102
M
M
® Check here if single emissions point source (Attachment F not required)
G
Process description, flow diagram and plot plan of emissions unit and/or
facility
® Check here if single emissions point source (Attachment G not required)
H
Operating & Maintenance (O&M) Plan — APCD Form Series 300
M
® Check here if true minor emissions source or application is for a general
permit (Attachment H not required)
I
Regulatory Analysis
17
® Check here to request APCD to complete regulatory analysis
(Attachment I not required)
J
Colorado Oil and Gas Conservation Commission (COGCC) 805 Series Rule
M
13
Requirements— Form APCD-105
Check here if source is not subject to COGCC 805 Series requirements
®
(Attachment J not required)
ocuu %-U111VIU C 11pp11callUn tU: %-oiorauo llepartment of rublic Health & Environment
APCD-SS-BI
4300 Cherry Creek Drive South
Denver, Colorado 80246-1530
Check box if facility is an existing Title V source: ❑ Send an additional application copy
Check box if refined modeling analysis included: ❑ Send an additional application copy
Check box if application is for major NA NSR or PSD permit: ❑ Send eight (8) total application copies
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