Extraction Process Permit Application

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This form shall be completed and signed by a representative of the property (site) applying for the permit(s). It shall be returned to Front Range Fire Rescue with complete plan review application fee payment.

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Business Information

Business Name

Phone

Fax

Business Address

City/Town

State/Province

ZIP/Postal Code

Permit Site Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Manager/Director Information

Manager/Director Name

Phone

Email Address

Business Details

Type of Extraction Proposed of Extraction Process (check all that apply)

LPG

Flammable Liquid

CO2

Other

Hazardous Material(s) Used in Extraction

Total Amount of Hazardous Materials Stored Onsite

Attach detailed hazardous materials inventory statement.

Hazardous Materials Inventory Statement

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Number of Extraction Units in Operation

Manufacturer and Model Number of Extraction Equipment

Attach applicable engineering approval(s) from Denver Fire Department, as needed.

Engineering Approval(s) from Denver Fire Department

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I, the undersigned, understand that Front Range Fire Rescue personnel will conduct a site inspection and if the installation does not comply with the adopted international fire code and amendments that the permit may be revoked without a refund.

Front Range Fire Rescue

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