A	B	C	D	E	F	G	H	I
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12		1. Please fill out the following worksheets:
13		Worksheet 1	Facility Information	Record facility name, address, city, county, zip code, and source nubmer in the boxes.
14		Worksheet 2	Requested Exposure Location Variances	Complete Worksheet 2 to request permission to model an exposure location(s) in a manner that differs from underlying zoning for that exposure location based on current land use.
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16		2. Please submit this Form in Excel format along with Form CAO521 as part of your Cleaner Air Oregon Modeling Protocol submittal. [OAR 340-245-0210(1)(a)(F)]

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6	Facility Information
7	Facility Name	Covanta Marion, Inc.
8	Facility Address	4850 Brooklake Road NE
9	City	Brooks
10	County	Marion
11	Region	Western
12	Zip Code	97305
13	Source Number	24-5398
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15	DEQ Regions
16	Eastern Region	Northwest Region	Western Region
17	Baker	Clackamas	Benton
18	Crook	Clatsop	Coos
19	Deschutes	Columbia	Curry
20	Gilliam	Multnomah	Douglas
21	Grant	Tillamook	Jackson
22	Harney	Washington	Josephone
23	Hood River	Yamhill	Lane (LRAPA)
24	Jefferson		Lincoln
25	Klamath		Linn
26	Lake		Marion
27	Malheur		Polk
28	Morrow		Yamhill
29	Sherman
30	Umatilla
31	Wallowa
32	Wasco
33	Wheeler

	B	C	D	E	F	G	H	I
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2	UTM Coordinates		Current		Land Use Authority Cited	Requested		Reason for Exposure Location Classification Variance
3	Easting	Northing	Zoning Designation	Exposure Scenario		Land Use	Exposure Scenario
4	502502	4988133	Exclusive Farm Use	Acute and Chronic (Residential, Worker)	Marion County Planning Department	Acute	Acute only	Open fields that are not developed with any residences