AES-02 Facility General Information {52053}

AES ­ 02 FACILITY GENERAL INFORMATION State Form 52053 (3-05) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT IDEM - Office of Air Quality Technical Support and Modeling Section ­ Mail Code 61-51 100 N. Senate Avenue Indianapolis, IN 46204-2251 Telephone: (317) 233-0178 or Toll Free: 1-800-451-6027 x30178 (within Indiana) http://www.emissions.IN.gov/ NOTES: · Use this form to complete all the necessary information regarding your facility. Please complete all the information. a.) County Code: c.) Facility Name: d.) ORIS ID Code (if applicable): e.) Year of Inventory: Section 1: Facility Identification and Inventory Year b.) Plant ID: Section 2: Physical Address a.) Source Address: b.) Source City, ZIP Code: Section 3: Mailing Address a.) Mailing Address: b.) Mailing City, State, ZIP Code: a.) UTM Vertical: b.) Latitude: Section 4: Source Coordinates UTM Horizontal: Longitude: Section 5: Industrial Classification a.) Primary NAICS Code: b.) Primary SIC Code: American LegalNet, Inc. www.FormsWorkflow.com