Fillable Tss Emissions Title V Froms

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Tss Emissions Title V Froms

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C:\Users\ssunny\AppData\Local\Microsoft\Windows\INetCache\IE\GHJABB9T\tss_emissions_word.doc May Y Leung5/3/2016
Engineering Division
Bay Area Air Quality Management District
375 Beale Street, Ste# 600, San Francisco, CA 94105
415-749-4990
Total Stationary Source
Emissions
FACILITY NAME:
FACILITY #:
I. STATIONARY SOURCE EMISSIONS
EMISSIONS
(tons per year)
PRE-MODIFICATION EMISSIONS
(tons per year)
EMISSIONS
CHANGE
(tons per year)
I certify that based on information and belief formed after reasonable inquiry, the answers, statements, and information contained in
this application (and supplemental attachments thereto) are true, accurate, and complete. This application consists of the
application forms provided by the Bay Area Air Quality Management District and supplemental attachments. I also certify that I am
the responsible official as defined in District Regulation 2, Rule 6.
Signature of Responsible Official
Print Name of Responsible Official
Title of Responsible Official and Company Name
Date:
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Completed 19 April 2020

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