Registration for Existing Sources

U nited States Environmental Protection Agency Program Address Phone Fax Web address	Reviewing Authority Program Address Phone Fax Web address
FEDERAL MINOR NEW SOURCE REVIEW PROGRAM IN INDIAN COUNTRY Registration for Existing Sources (FORM REG)
This application form is not yet approved by the Office of Management and Budget. Once it is approved by OMB, this space will include the control number and PRA requirements 5 CFR 1320.6

Please submit information to:

[Reviewing Authority

Address

Phone]

A. GENERAL FACILITY INFORMATION

1. Company Name			2. Facility Name
3. Type of Operation			4. Portable Source?  Yes  No 5. Temporary Source?  Yes  No
6. NAICS Code			7. SIC Code
8. Physical Address (home base for portable sources)
9. Reservation*	10. County*	11a. Latitude*		11b. Longitude*
12a. Quarter-Quarter Section*	12b. Section*	12c. Township*		12d. Range*

* Provide all locations of operation for portable sources

B. CONTACT INFORMATION

1. Owner Name				Title
Mailing Address
Email Address
Telephone Number		Facsimile Number
2. Operator Name (if different from owner)			Title
Mailing Address
Email Address
Telephone Number	Facsimile Number
3. Facility Contact			Title
Mailing Address
Email Address
Telephone Number		Facsimile Number
4. Compliance Contact		Title
Mailing Address
Email Address
Telephone Number		Facsimile Number

C. ATTACHMENTS

Include all of the following information as attachments to this form

 Narrative description of the operations

 Identification and description of all emission units and air pollution generating activities; include portable equipment

 Identification and description of any existing air pollution control equipment and compliance monitoring devices or activities

 Type of fuels used

 Type raw materials used

 Final product produced

 Estimates of the total actual emissions from the air pollution source for the following air pollutants: particulate matter, PM10, PM2.5, sulfur oxides (SOx), nitrogen oxides (NOx), carbon monoxide (CO), volatile organic compound (VOC), lead (Pb) and lead compounds, ammonia (NH3), fluorides (gaseous and particulate), sulfuric acid mist (H2SO4), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds, including all calculations for the estimates.

 Any existing limitations on source operation affecting emissions or any work practice standards, where applicable, for all regulated NSR pollutants at your source.

 Other

[Disclaimers] The public reporting and recordkeeping burden for this collection of information is estimated to average 6 hours per response. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

D. TABLE OF ESTIMATED EMISSIONS

The following estimates of the total emissions in tons/year for all pollutants contained in your worksheet stated above should be provided.

Pollutant	Total Actual Emissions (tpy)
PM
PM10
PM 2.5
SOx
NOx
CO
VOC
Pb
NH3
Fluorides
H2SO4
H2S
TRS
RSC

PM - Particulate Matter

PM₁₀ - Particulate Matter less than 10 microns in size

PM_2.5 - Particulate Matter less than 2.5 microns in size

SOx - Sulfur Oxides

NOx - Nitrogen Oxides

CO - Carbon Monoxide

VOC - Volatile Organic Compound

Pb - Lead and lead compounds

NH₃ - Ammonia

Fluorides - Gaseous and particulates

H₂SO₄ - Sulfuric Acid Mist

H₂S - Hydrogen Sulfide

TRS - Total Reduced Sulfur

RSC - Reduced Sulfur Compounds

Emissions calculations must include fugitive emissions if the source is one the following listed sources, pursuant to CAA Section 302(j):

(a) Coal cleaning plants (with thermal dryers);

(b) Kraft pulp mills;

(c) Portland cement plants;

(d) Primary zinc smelters;

(e) Iron and steel mills;

(f) Primary aluminum ore reduction plants;

(g) Primary copper smelters;

(h) Municipal incinerators capable of charging more than 250 tons of refuse per day;

(i) Hydrofluoric, sulfuric, or nitric acid plants;

(j) Petroleum refineries;

(k) Lime plants;

(l) Phosphate rock processing plants;

(m) Coke oven batteries;

(n) Sulfur recovery plants;

(o) Carbon black plants (furnace process);

(p) Primary lead smelters;

(q) Fuel conversion plants;

(r) Sintering plants;

(s) Secondary metal production plants;

(t) Chemical process plants

(u) Fossil-fuel boilers (or combination thereof) totaling more than 250 million British thermal units per hour heat input;

(v) Petroleum storage and transfer units with a total storage capacity exceeding 300,000 barrels;

(w) Taconite ore processing plants;

(x) Glass fiber processing plants;

(y) Charcoal production plants;

(z) Fossil fuel-fired steam electric plants of more that 250 million British thermal units per hour heat input, and

(aa) Any other stationary source category which, as of August 7, 1980, is being regulated under section 111 or 112 of the Act.

Instructions

Please answer all questions. If the item does not apply to the facility and its operations write “n/a”. If the answer is not known write "unknown".

A. General Facility Information

1. Company Name: Provide the complete company name. For corporations, include divisions or subsidiary name, if any.

2. Facility Name: Provide the facility name. Please note that a facility is a site, place, location, etc… that may contain one or more air pollution emitting units.

3. Type of Operation: Indicate the generally accepted name for the operation (i.e., asphalt plant, gas station, dry cleaner, sand & gravel mining, oil and gas wellsite, tank battery, etc.).

4. Portable Source: Does the facility operate in more than one location? Some examples of portable sources include asphalt batch plants and concrete batch plants.

5. Temporary Source: A temporary source, in general, would have emissions that are expected last less than 2 years. Do you expect to cease operations within the next 2 years?

6. NAICS Code: North American Industry Classification System. The NAICS Code for your facility can be found at the following link  North American Industry Classification System (http://www.census.gov/epcd/naics/nsic2ndx.htm#S1).

7. SIC Code: Standard Industrial Classification Code. Although the new North American Industry Classification System (NAICS) has replaced the SIC codes, much of the Clean Air Act permitting processes continue to use these codes. The SIC Code for your facility can be found at the following link  Standard Industrial Classification Code (http://www.osha.gov/pls/imis/sic_manual.html).

8. Physical Address: Provide the actual address of where the facility is operating, not the mailing address. Include the State and the ZIP Code.

9. Reservation: Provide the name of the Indian reservation within which the facility is operating.

10. County: Provide the County within which the facility is operating.

11a & 11b. Latitude & Longitude: These are GPS (global positioning system) coordinates. This information can be provided in decimal format or degree-minute-second format.

12a – 12d. Section-Township-Range: Please provide these coordinates in Quarter-Quarter Section/Section/Township/Range. (e.g., SW ¼, NE ¼ /S36/T10N/R21E).

B. Contact Information

Please provide the information requested in full.

1. Owners: List the full name (last, middle initial, first) of all owners of the facility.

2. Operator: Provide the name of the operator of the facility if it is different from the owner(s).

3. Facility Contact: The facility contact must be the local contact authorized to receive requests for data and information.

4. Compliance Contact: The compliance contact must be the local contact responsible for the facility’s compliance with this rule. If this is the same as the Facility Contact please note this on the form.

C. Attachments

The information requested in the attachments will enable EPA to understand the type of facility being registered and the nature and extent of the air pollutants being emitted.

D. Total Actual Emissions

1. Total actual emissions are the current actual emissions at your facility. Current actual emissions for a pollutant is expressed in tons per year and generally is calculated by multiplying the actual hourly emissions rate in pounds per hour (lbs/hr) times actual hours operated (which is the number of hours in a year) and dividing by 2,000 (which is the number of pounds in a ton).

2. For an existing air pollution source, the current actual emissions are the actual rate of emissions for the preceding calendar year and should be calculated using the actual operating hours, production rates, in-place control equipment, and types of materials processed, stored, or combusted during the preceding calendar year.

3. The emission estimates can be based upon actual test data or, in the absence of such data, upon procedures acceptable to the Reviewing Authority. The following procedures are generally acceptable for estimating emissions from air pollution sources:

(i) Source-specific emission tests;

(ii) Mass balance calculations;

(iii) Published, verifiable emission factors that are applicable to the source. (i.e manufacturer specifications).

(iv) Other engineering calculations; or

(v) Other procedures to estimate emissions specifically approved by the Reviewing Authoritu.

3. Guidance for estimating emissions can be found at http://www.epa.gov/ttn/chief/efpac/index.html.