Farabee Form

Contact Phone:			Facility ID:

40 CFR part 63.6650 compliance period: January 1, 2023 through June 30, 2023
(postmarked July 2023)

Responsible Official Printed Name:		Title:

Address (if different from facility)

City:			State:			Zip Code:

List of sources applicable to this report:

1. There were no deviations from any emission or operating limitations during the reporting period.

2. There was no time that the CPMS was out of control during the reporting period.

I certify the information and statements contained herein are accurate to the best of
my knowledge.		has complied with the relevant standard.


Signature of Responsible Official		Date