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Get S: Solid Waste P&E Otis REVISED FORM DC .wpd - City Of Chicago - Cityofchicago

OF CHICAGO DATE OF INSPECTION AIR POLLUTION CONTROL PERMIT APPLICATION FORM FOR DRY CLEANING MACHINE BUSINESS INFORMATION NAME: STREET ADDRESS: CITY: STATE: ZIP: ENVIRONMENTAL CONTACT PERSON: PHONE: OWNER OR OPERATOR INFORMATION 1) NAME: 2) STREET ADDRESS: 3) CITY: 4) STATE: 5) ZIP: 6) FORM COMPLETED BY: SIGNATURE: EQUIPMENT INFORMATION TYPE OF MACHINE: DRY TO DRY MAKE AND MODEL: TYPE OF CLEANING SOLVENT: TYPE OF CONTROL DEVICE: TRANSFER NUMBER OF UNITS: PERCH.

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