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["Ambient Background Concentrations Request Form"]
[]
["This form is used to request data needed for air pollutant source impact analysis "]
["(air quality modeling)."]
[]
["You may request data for criteria pollutants."]
[]
["Please note that, if you are requesting a Meteorological Data Set for use in modeling,"]
["You will need to contact Emmett Malone to file a separate request."]
["(Email Emmett.Malone@state.co.us)"]
[]
["For Background Concentration Requests, please:"]
["1. Fill out this Excel spreadsheet"]
["2. Save it on your hard drive as an Excel Macro spreadsheet (.xlsm extension)."]
["      Use the county name and project name for the file name (ie: countymyproject.xlsm)"]
["3. Email a note to nancy.chick@state.co.us with the form as an attachment."]
[]
["Your Contact Information .  Please fill out in Column B. "]
[]
["Title  (Mr, Ms, Mrs, Dr, etc)"]
["First Name"]
["Last Name"]
["Telephone "]
["Email"]
[]
[]
["Name of Firm Requesting Background Estimate"]
["Steet Address"]
["City"]
["State"]
["Zip Code"]
[]
["Information about the Project You Will Be Analyzing"]
[]
["Sponsoring Company"]
["Project Name"]
["Project County"]
[]
["Project Location (Must be Supplied)"]
[]
["NAD 83, Decimal Degrees (Preferred Format)"]
["NAD 83 Latitude"]
["NAD 83 Longitude"]
[]
["OR"]
[]
["NAD 27, Decimal Degrees (Alternate Format)"]
["NAD 27 Latitude"]
["NAD 27 Longitude"]
[]
["Ambient Air Pollutants That You Need Background Estimates For:"]
[]
["Type Yes in  Boxes in B for only the pollutants you will need.  This will allow for a faster response."]
[]
["Background Estimates Needed"]
[]
["Carbon Monoxide (CO)"]
["Ozone (O3)"]
["Nitrogen Dioxide (NO2)"]
["Sulfur Dioxide (SO2)"]
["Particulate Matter 10 Microns or Less In Diameter (PM10)"]
["Particulate Matter 2.5 Microns or Less In Diameter (PM2.5)"]
["Lead (Pb)"]
[]
[]
[]
["Project Comments"]
["Type any additional information about the project in the adjacent box. "]

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