NONMETALLIC MINERAL PROCESSING GENERAL PERMIT
APPLICATION STATEMENT
(please print or type)
Certification:
"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering and evaluating the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations."
Signatures: Date:
Signatures: Date:
Name of persons signing above: (printed or typed)
(printed or typed)
Titles:
For Department use only:
Accepted/Not accepted by: Date:
Required attachments:
NONMETALLIC MINERAL PROCESSING GENERAL PERMIT
NOTICE OF TERMINATION
Name:
Mailing address:
City: State: Zip code: Phone:
Name:
Address:
City: State: Zip code:
"I certify under penalty of law that all emissions associated with the identified facility have been eliminated, that the facility authorized by the general permit has been determined to be shutdown in accordance with 9VAC5-20-220, or that a permit has been issued covering the facility under the provisions of 9VAC5 Chapter 80 (9VAC5-80). I understand that by submitting this notice of termination, I am no longer authorized to operate under the general permit. I also understand that the submittal of this notice of termination does not release an owner from liability for any violations of this permit under the Air Pollution Control Law."
Signatures: Date:
Date:
Name of persons signing above: (printed or typed)
(printed or typed)
Titles:
9 Va. Admin. Code § 5-510-130
Statutory Authority
§ 10.1-1308 of the Code of Virginia.