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r <br /> Wro Minnesota Pollution Control Agency <br /> Environmental Analysis and Outcomes Division <br /> Environmental Data Management Unit <br /> Michael Smith <br /> 520 Lafayette Road N <br /> St. Paul, MN 55155 -4.194 <br /> Xo <br /> Stationary Int Combustion Engines, Generator(s): <br /> Report either fuel usage hours of operation, but do not list the same information both ways. <br /> ;1 Fuel.usag <br /> 1•,- Fuel Type Fuel Burned Units <br /> 1o.'1 2 distilate oil, units less than 600 hp gallons <br /> No. 1 2 distilate oil, units greater than 600 hp gallons <br /> Natural gas, 4 cycle units cubic feet <br /> Natural gas, 2 cycle units cubic feet <br /> 1 <br /> Hours of operation <br /> Hours of Horse Power <br /> Frei Type Operation Design Capacity Units <br /> horsepower <br /> horsepower <br /> horsepower <br /> Miscellaneous Fuel Usage, AC Heater: Fuel Type_ Amount Fuel Burned Units <br /> Natural g as y 50 cubic feet C) <br /> No. 1 2 distilate oil gallons <br /> No. 5 8 residual/waste oil gallons <br /> Liquefield petroleum gas gallons <br /> Unpaved Roads: <br /> Round trip miles traveled on Credit Record Keeping <br /> unpaved roads (")Option (circle one) <br /> a off) 50% 7596 <br /> Natural gas may be identified in ccf (hundred cubic feet), therms, or feet on bill If natural gas amounts are not in cubic feet, please identify <br /> what units you are giving natural gas amounts. <br /> C`) Please do not Report the total vehicle miles traveled. Report the distance of one round trip only. <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervised by qualified personnel. The <br /> information submitted is, to the best of my knowledge and belief, true, accurate and complete. 1 understand that the data provided in this document <br /> will be used by the MPCA to calculate a fee, which the facility will be required to pay under Minn. R. 7002.0065, based on the tons of pollution emitted by <br /> the facility. <br /> Sig to 11 of Compan Date: i I ial: <br /> t ra <br /> g �lkk I JI kW 1 /0 <br /> Name and Title of Company Offic"al (please print): <br /> 1 tida S 't 44 £I' MO ila -1/N <br /> Forms must be received by April 1, please mail us this form with an original signature. A copied or faxed signature is unacceptable. <br /> Please contact Michael Smith (651) 757 -2733. with any questions. <br /> aq-ei3 -14 <br />