Application For Terminal FacuIlity license Please complete this form in the accordance with the instructions to ensure the proper handling of your application. Print or type unless otherwise noted. You must submit the application fee along with this form. Part I: Application Type Enter a check in the appropriate box identifying application type. DEP I ltilt ONLY Rec'd by Date Mil STX Application No., This application is for (check one): CI A new license A renewed of an existing license D A modification of an existing license If other than new, provide existing license number: Part II: License Fee Information Each registrant shall obtain from DPNR DEP a license for each of its terminal facilities in the territory and shall pay an amount; not to exceed five hundred ($500) dollars, determined by DEP upon the basis of the total capacity of the terminal facility. In addition a two hundred and fifty ($250) dollars permit processing fee. DEP will not process an application unless the required fee has been paid. Pad III: Applicant Information I. MI In the name of the applicant(s) as indicated on (lie Permit Application Transmittal F011111 Applicant: Little St. James Island phone: 340-775-8100 ext.: Fax: 340-775-8134 O Enter a check mark if there are co-applicants. If so, label and attach additional sheet(s) with the required information as supplied above. 2. List primary contact for departmental correspondence and inquires, if different, Name: Brice Gordon Mailing Address: 6100 Red Hook Quarter B-3 City: St. Thomas State: VI zip Code: 00802 Business Phone: 340-513-9855 ext: pax: 340-775-8134 Contact person: Brice Gordon Title; Manager EFTA00292588