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Notice of Relocation of Portable Equipment
Plant Information
/ /Today’s Date:
/Company Name:
/Mailing Address:
/City:
/ /State:
/ /Zip Code:
/Person to Contact regarding this relocation:
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Phone Number:
/ /On-site Contact person (operating the plant):
//
Phone Number:
/ /Air Quality Plant Number (this is your PP-###-000 number):
/ /Type of Air Pollution Control Equipment:
/List of all Equipment being moved and the corresponding DNR Air Permit Number
(**Permits for equipment listed below shall be kept on site).
1.
/ /1.
/2.
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/3.
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/4.
/ /4.
/5.
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/Relocation Information
Anticipated Relocation Date:
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(at least 7 days after submittal date of this notice, unless moving into an area currently classified as nonattainment or under a maintenance plan for ambient air quality standards- IAC 22.3(3)”f”)
Anticipated Duration at New Site:
/ /Present Location (where plant is currently located):
/Moving to: County:
/ /Nearest City:
/Distance from Site to Nearest Dwelling Unit:
/ /Field Office/Local Air Program move is occurring in:
/#1 #2 #3 #4 #5 #6 Polk Linn
Exact Plant Location (give plant coordinates and/or attach map of new location):
/7900 Hickman Rd Ste 1, Windsor Heights IA 50324 515-725-9500 FAX 515-725-9501 www.IowaCleanAir.gov
04/2017 cmc DNR Form 542-1362