701 W. Ormsby Ave.Suite 303
Louisville, KY 40203
(502) 574-6000
FAX: (502) 574-5137
Permit Application and Renewal
Form AP-100H
Applicable Requirements
Plant Name: / Plant ID:
Date of submission
Applicable Regulations
Emission Process/PointName: / Emission Process/Point:
Pollutant:
Special conditions:
Emission regulation: / Emission standard:
Recordkeeping regulation: / Recordkeeping requirement:
Reporting regulation: / Reporting requirement:
Monitoring regulation: / Monitoring requirement:
Testing regulation: / Testing requirement:
Emission Process/PointName: / Emission Process/Point:
Pollutant:
Special conditions:
Emission regulation: / Emission standard:
Recordkeeping regulation: / Recordkeeping requirement:
Reporting regulation: / Reporting requirement:
Monitoring regulation: / Monitoring requirement:
Testing regulation: / Testing requirement:
Emission Process/PointName: / Emission Process/Point:
Pollutant:
Special conditions:
Emission regulation: / Emission standard:
Recordkeeping regulation: / Recordkeeping requirement:
Reporting regulation: / Reporting requirement:
Monitoring regulation: / Monitoring requirement:
Testing regulation: / Testing requirement:
Page ___ of ___
March 2016
Instructions for Applicable Requirements
Form AP-100H
All pollutants emitted by each emission unit must be accounted for. Use multiple copies of this form as necessary.
Plant Name Enter the plant name as it appears in Form AP-100A.
Plant IDThis is the identification number assigned to the source by the District. If this application is for a new source for which an ID has not been assigned, this space may be left blank.
Applicable Regulations
Emission Process/PointNameEnter the emission process name as it was listed on Form AP-100B. If this is the same as in the immediately preceding block, you may enter "SAME."
Emission Process/PointIDEnter the emission process ID number as it was listed on Form AP-100B.
PollutantEnter the pollutant whose applicable requirements are to be described.
Special ConditionsProvide a description of any conditions or restrictions on operation that affect emissions or operations. (For example, only one unit may be operated at a time.)
Emission RegulationsList specific emission regulations affecting this emission unit and pollutant.
Emission StandardList any standards or limitations set forth by the cited regulations.
Recordkeeping RegulationsList specific recordkeeping regulations affecting this emission unit and pollutant.
Recordkeeping RequirementDescribe any specific recordkeeping required by the cited regulations.
Reporting RegulationsList specific reporting regulations affecting this emission unit and pollutant.
Reporting RequirementsDescribe any reporting required by the cited regulations.
Monitoring RegulationsList specific monitoringregulations affecting this emission unit and pollutant.
Monitoring RequirementsDescribe monitoring required by the cited regulations.
Testing RegulationsList specific testing regulations affecting this emission unit and pollutant.
Testing RequirementsDescribe testing that is required by the cited regulations.
March 2016