NMED - AIR QUALITY BUREAU
NOTICE OF ELECTION TO COMPLY WITH REVISED 22.214.171.1242.E(2) and 126.96.36.1994.B(4) NMAC
Source Address (physical location):
Existing Operating Permit Number:
This form is effective seven (7) days after submittal to the AQB, and constitutes an amendment of the permit pursuant to 188.8.131.522.H(1) NMAC. This form shall be attached to and shall become part of the relevant permit.
The permittee elects to comply with revised 184.108.40.2062.E(2) NMAC and 20.2.70 304.B.(4) NMAC. Accordingly, the following permit terms and conditions related to the former version of 220.127.116.112.E(2) and 20.2.70 304.B.(4) NMAC are no longer applicable to the facility:
I, , hereby certify on
behalf of , that the information
and data submitted in this form are as complete, true and accurate as possible, to the best
of my personal knowledge and professional expertise and experience. Signed this day of , 20 , upon my oath of affirmation,
before a notary of the State of .
RESPONSIBLE COMPANY OFFICIAL DATE
__________ ______ PRINTED NAME TITLE
Subscribed and sworn to before me on this day of , 20 .
My authorization as a Notary of the State of expires on the
day of , 20 .
NOTARY'S SIGNATURE DATE
NOTARY'S PRINTED NAME NOTARY SEAL