Version 1.2 - 3/16/2015
- -
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section II - Identification InformationProject Description (continuation)
Continuation Sheet ____ of ____
Version 1.2 - 3/16/2015
- -
Continuation Sheet ____ of ____
DEC ID
Section III - Facility InformationFacility Description (continuation)
New York State Department of Environmental ConservationAir Permit Application Form
Version 1.2 - 3/16/2015
- -
Continuation Sheet ____ of ____
Facility Applicable Federal Requirements (continuation)Paragraph SubclauseClauseSubparagraphTitle Type Part Subpart Section Subdivision
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section III - Facility Information
Version 1.2 - 3/16/2015
- -
Continuation Sheet ____ of ____
Subdivision Paragraph Subparagraph Clause Subclause
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section III - Facility InformationFacility State Only Requirements (continuation)
Title Type Part Subpart Section
Version 1.2 - 3/16/2015
- -
Limit Limit UnitsUpper Lower Code Description
Continuation Sheet ____ of ____
Code DescriptionCode Description Code DescriptionAveraging Method Reporting RequirementsMonitoring Frequency
ParameterCode Description
Manufacturer Name/Model No.
Work PracticeType
Process MaterialCode Description
Reference Test Method
Monitoring Information
Description
State Only Requirement Capping
CAS No. Contaminant Name
Continuous Emission Monitoring Monitoring of Process or Control Device Parameters as a Surrogate Intermittent Emission Testing Work Practice Involving Specific Operations Ambient Air Monitoring Record Keeping/Maintenance Procedures
Applicable Federal Requirement
Paragraph Subparagraph Clause SubclauseTitle Type Part Subpart Section Subdivision
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section III - Facility InformationFacility Compliance Certification (continuation)
Rule Citation
Version 1.2 - 3/16/2015
- -
Continuation Sheet ____ of ____
Actual(lbs/yr)
CAS No. Contaminant NamePTE
Range (lbs/yr)
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section III - Facility InformationFacility Emissions Summary (continuation)
Version 1.2 - 3/16/2015
- -
-
Continuation Sheet ____ of ____
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationEmission Unit Description (continuation)
Emission Unit
Version 1.2 - 3/16/2015
- -
Continuation Sheet ____ of ____
Building ID Building Name
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationBuilding (continuation)
Emission Unit OrientationWidth (ft)Length (ft)
Version 1.2 - 3/16/2015
- -
-
-
-
-
-
Continuation Sheet ____ of ____
Date of RemovalExit Velocity (FPS)
Exit Flow (ACFM)
NYTM (E)(km)
NYTM (N)(km)
Building Distance to Property Line (ft)
Width (in)
Emission Unit Emission Point
Ground Elevation (ft)
Height(ft)
Height Above Structure (ft)
Inside Diameter (in)
Exit Temp.(oF)
Cross SectionLength (in)
Date of RemovalExit Velocity (FPS)
Exit Flow (ACFM)
NYTM (E)(km)
NYTM (N)(km)
Building Distance to Property Line (ft)
Width (in)
Emission Unit Emission Point
Ground Elevation (ft)
Height(ft)
Height Above Structure (ft)
Inside Diameter (in)
Exit Temp.(oF)
Cross SectionLength (in)
Date of RemovalExit Velocity (FPS)
Exit Flow (ACFM)
NYTM (E)(km)
NYTM (N)(km)
Building Distance to Property Line (ft)
Width (in)
Emission Unit Emission Point
Ground Elevation (ft)
Height(ft)
Height Above Structure (ft)
Inside Diameter (in)
Exit Temp.(oF)
Cross SectionLength (in)
Date of RemovalExit Velocity (FPS)
Exit Flow (ACFM)
NYTM (E)(km)
NYTM (N)(km)
Building Distance to Property Line (ft)
Width (in)
Emission Unit Emission Point
Ground Elevation (ft)
Height(ft)
Height Above Structure (ft)
Inside Diameter (in)
Exit Temp.(oF)
Cross SectionLength (in)
Date of RemovalExit Velocity (FPS)
Exit Flow (ACFM)
NYTM (E)(km)
NYTM (N)(km)
Building Distance to Property Line (ft)
Width (in)
Emission Unit Emission Point
Ground Elevation (ft)
Height(ft)
Height Above Structure (ft)
Inside Diameter (in)
Cross SectionExit Temp.(oF) Length (in)
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationEmission Point Information (continuation)
Version 1.2 - 3/16/2015
- -
-
Continuation Sheet ____ of ____
Code DescriptionDesign
CapacityDesign Capacity Units Waste Feed Waste Type
Code Description Code Description
Emission Source Date of Construction
Date of Operation
Date of Removal
Control Type Manufacturer's Name/Model No.ID Type Code Description
Code DescriptionDesign
CapacityDesign Capacity Units Waste Feed Waste Type
Code Description Code Description
Emission Source Date of Construction
Date of Operation
Date of Removal
Control Type Manufacturer's Name/Model No.ID Type Code Description
Code DescriptionDesign
CapacityDesign Capacity Units Waste Feed Waste Type
Code Description Code Description
Emission Source Date of Construction
Date of Operation
Date of Removal
Control Type Manufacturer's Name/Model No.ID Type Code Description
Code DescriptionDesign
CapacityDesign Capacity Units Waste Feed Waste Type
Code Description Code Description
Emission Source Date of Construction
Date of Operation
Date of Removal
Control Type Manufacturer's Name/Model No.ID Type Code Description
Code DescriptionDesign
CapacityDesign Capacity Units Waste Feed Waste Type
Code Description Code Description
Emission Source Date of Construction
Date of Operation
Date of Removal
Control Type Manufacturer's Name/Model No.ID Type Code Description
Waste TypeCode Description
Design Capacity
Design Capacity UnitsCode Description
Waste FeedCode Description
Control TypeCode Description
Manufacturer's Name/Model No.
Date of Construction
Date of Operation
Emission Unit
Emission SourceID Type
Date of Removal
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationEmission Source/Control (continuation)
Version 1.2 - 3/16/2015
- -
-
-Emission Unit Process
Emission Point Identifier(s)
Emission Point Identifier(s)
Continuation Sheet ____ of ____
Emission Source/Control Identifier(s)
Operating ScheduleBuilding Floor/Location
Source Classification Code (SCC)
Total Throughput Throughput Quantity UnitsQuantity/Hr Quantity/Yr Code Description
Description
Hrs/Day Days/Yr
Building Floor/Location
Emission Source/Control Identifier(s)
Operating ScheduleHrs/Day Days/Yr
Code DescriptionSource Classification Code
(SCC)Total Throughput
Quantity/Hr Quantity/YrThroughput Quantity Units
Emission Unit Process
Description
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationProcess Information (continuation)
Confidential Operating at Maximum Capacity
Confidential Operating at Maximum Capacity
Version 1.2 - 3/16/2015
- -
Subpart Section Subdiv. Parag.
Continuation Sheet ____ of ____
Type Part Clause
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationEmission
UnitEmission
PointProcess
Emission Source
Emission Unit Applicable Federal Requirements (continuation)Title Subparag. Subcl.
Version 1.2 - 3/16/2015
- -
Parag.Subdiv.SectionSubpart
Continuation Sheet ____ of ____
Subparag. Clause Subcl.Title Type Part
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationEmission
UnitEmission
PointProcess
Emission Source
Emission Unit State Only Requirements (continuation)
Version 1.2 - 3/16/2015
- -
Applicable Federal Requirement State Only Requirement Capping
Subparagraph Clause
Emission Unit CAS No. Contaminant Name
Continuation Sheet ____ of ____
Description
Code Description Code Description Code DescriptionAveraging Method Monitoring Frequency Reporting Requirements
LimitUpper
Limit UnitsCode Description
ParameterCode Description
Manufacturer Name/Model No.
Work PracticeType
Process MaterialCode Description
Reference Test Method
Lower
Emission Point Process
Subclause
Section IV - Emission Unit InformationEmission Unit Compliance Certification (continuation)
Rule CitationTitle Type Part Subpart Section Subdivision Paragraph
Monitoring Information Continuous Emission Monitoring Intermittent Emission Testing Ambient Air Monitoring
Monitoring of Process or Control Device Parameters as a Surrogate Work Practice Involving Specific Operations Record Keeping/Maintenance Procedures
Emission Source
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Version 1.2 - 3/16/2015
- -
State Only RequirementEmission Source
Continuation Sheet ____ of ____
Description State Only Requirement
Emission Unit Emission Point Process
Subdivision Paragraph Subparagraph Clause Subclause
Applicable Federal RequirementEmission Source
Rule CitationTitle Type Part Subpart Section
Description
Emission Unit Emission Point Process Applicable Federal Requirement State Only Requirement
Emission Source
Subdivision Paragraph Subparagraph Clause SubclauseRule Citation
Title Type Part Subpart Section
Description
Emission Unit Emission Point Process
Paragraph Subparagraph Clause SubclauseTitle Type Part Subpart Section Subdivision
Applicable Federal Requirement
Description
Rule Citation
Emission Point ProcessEmission Unit Applicable Federal Requirement State Only Requirement
Emission Source
Subparagraph Clause Subclause
Section IV - Emission Unit InformationDetermination of Non-Applicability (continuation)
Rule CitationTitle Type Part Subpart Section Subdivision Paragraph
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Version 1.2 - 3/16/2015
- -
-
-
-
-
-
Continuation Sheet ____ of ____
ERP How Determined
PTE Standard Units PTE How Determined Actual(lbs/hr) (lbs/yr) (standard units) (lbs/hr) (lbs/yr)
PTE Standard Units PTE How Determined Actual(lbs/hr) (lbs/yr) (standard units) (lbs/hr) (lbs/yr)
ERP How Determined
Emission Unit Process
CAS No. Contaminant Name%
Throughput%
Capture%
ControlERP (lbs/hr)
PTE Standard Units PTE How Determined Actual(lbs/hr) (lbs/yr) (standard units) (lbs/hr) (lbs/yr)
Emission Unit Process
CAS No. Contaminant Name%
Throughput%
Capture%
ControlERP (lbs/hr)
ERP How Determined
Emission Unit Process
CAS No. Contaminant Name%
Throughput%
Capture%
ControlERP (lbs/hr)
PTE Standard Units PTE How Determined Actual(lbs/hr) (lbs/yr) (standard units) (lbs/hr) (lbs/yr)
Emission Unit Process
CAS No. Contaminant Name%
Throughput%
Capture%
ControlERP (lbs/hr)
ERP How Determined
Actual(lbs/hr) (lbs/yr)
PTE(lbs/hr) (lbs/yr) (standard units)
Standard Units PTE How Determined
ERP How Determined
CAS No. Contaminant Name%
Throughput%
Capture%
ControlERP (lbs/hr)
Air Permit Application FormDEC ID
Section IV - Emission Unit Information
Emission Unit Process
Process Emissions Summary (continuation)
New York State Department of Environmental Conservation
Version 1.2 - 3/16/2015
- -
-
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationEmission Unit
Emission Unit Emissions Summary (continuation)
CAS No. Contaminant Name
ERP (lbs/yr)PTE Emissions Actual Emissions
(lbs/hr) (lbs/yr) (lbs/hr) (lbs/yr)
CAS No. Contaminant Name
ERP (lbs/yr)PTE Emissions Actual Emissions
(lbs/hr) (lbs/yr) (lbs/hr) (lbs/yr)
CAS No. Contaminant Name
ERP (lbs/yr)PTE Emissions Actual Emissions
(lbs/hr) (lbs/yr) (lbs/hr) (lbs/yr)
CAS No. Contaminant Name
ERP (lbs/yr)PTE Emissions Actual Emissions
(lbs/hr) (lbs/yr) (lbs/hr) (lbs/yr)
CAS No. Contaminant Name
ERP (lbs/yr)PTE Emissions Actual Emissions
(lbs/hr) (lbs/yr) (lbs/hr) (lbs/yr)
Continuation Sheet ____ of ____
CAS No. Contaminant Name
ERP (lbs/yr)PTE Emissions Actual Emissions
(lbs/hr) (lbs/yr) (lbs/hr) (lbs/yr)
CAS No. Contaminant Name
ERP (lbs/yr)PTE Emissions Actual Emissions
(lbs/hr) (lbs/yr) (lbs/hr) (lbs/yr)
Version 1.2 - 3/16/2015
- -
Subpart
Section IV - Emission Unit InformationCompliance Plan (continuation)
Consent Order / /
Emission Unit
ProcessEmission Source Title Subparag.
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
SubclauseApplicable Federal Requirement
R/I Date ScheduledRemedial Measures/Intermediate Milestones
Type Part ClauseParag.Subdiv.Section
Continuation Sheet ____ of ____
Certified progress reports are to be submitted every 6 months beginning
Version 1.2 - 3/16/2015
- -
Emission Source
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationRequest for Emission Reduction Credits (continuation)
Emission Reduction Description
Contaminant Emission Reduction Data
CAS No.ERC (lbs/yr)
Contaminant NameNetting Offset
Continuation Sheet ____ of ____
Version 1.2 - 3/16/2015
- -
- - /
Emission Source
Source of Emission Reduction Credit - Facility
New York State Department of Environmental ConservationAir Permit Application Form
DEC ID
Section IV - Emission Unit InformationUse of Emission Reduction Credits (continuation)
Proposed Project Description
City/ Town/ VillageEmission Source
CAS No.ERC (lbs/yr)
Contaminant NameNetting Offset
Continuation Sheet ____ of ____
Permit ID
Name
Location Address
State Zip