Form No. / A-L-0022
Effective Date / 01-16-2007
Revision No. / 03
Last Revision Date / 09-04-2014

Section I: Miscellaneous Emission Unit

Emission Unit ID:

  1. Equipment Description

  1. Type of Emission Unit -
(Loading rack, degreaser, etc.)
  1. Description -
(Size, capacity, etc.)
  1. Type of Emissions -
(PM, VOC, NOx, HAPs, etc.)
  1. Nature of Emissions -
(Fugitive dust, paint room, etc)
  1. Date of Manufacture -

  1. Date of Installation -

  1. 40 CFR Part 60 Applicability
/ No Yes Subpart(s):
  1. 40 CFR Part 63 Applicability
/ No Yes Subpart(s):
  1. 40 CFR Part Applicability
/ No Yes Subpart(s):
  1. Associated Chemical Usage

Chemical Compound Name:
  1. Actual Usage (gal or lb/year):

  1. Density of Chemical (lb/gal):

  1. Weight Percent VOC:

  1. List each HAP below:
/ Weight Percentage
  1. Total HAP (lb/year):

  1. Total VOC (lb/year):

Section I: Miscellaneous Emission Unit (cont.)

Emission Unit ID (cont):

  1. Control Equipment

Description / Pollutant(s) Controlled / Efficiency %
(capture/control) / Installation
Date
  1. BACT/BPT

BACT was established <15 Years Ago

BPT analysis is attached

  1. Current or Proposed Emission Limits

Fuel Type:
Pollutant / Standard / Units / Avg. Period / Regulatory Reference

Section I: Miscellaneous Emission Unit (cont.)

Emission Unit ID (cont):

Duplicate page as needed to accommodate all fuel types for this Emission Unit.

Fuel Type:
Pollutant / Standard / Units / Avg. Period / Regulatory Reference

Section I: Miscellaneous Emission Unit (cont)

Emission Unit ID (cont):

  1. Monitoring
  1. Is this Unit subject to Compliance Assurance Monitoring (CAM) under 40 CFR Part 64?

Yes No

If yes, for what pollutant(s)?

  1. This Unit is equipped with the following Certified Continuous Emission Monitoring Systems:

Opacity / TRS / NH3
SO2 / Mercury / PM
NOx / O2 / Other:
CO / CO2
  1. Monitors

Item to be Monitored / Unit of Measure / Monitoring Tool/Method / Frequency
  1. Stack Data

How are the emissions released? / Fugitive Stack
For stack emissions only:
  1. Stack ID -

  1. Orientation -
/ Vertical Horizontal
  1. Rain Cap -
/ Yes No
  1. Height (feet) -

  1. Inside Diameter (feet) -

  1. Gas Exit Flow Rate (acfm) -

  1. Gas Exit Velocity (ft/sec) -

  1. Exit Temperature (deg F) -

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