Registration for Minor Sources

A. GENERAL SOURCE INFORMATION

1. Company Name*

Provide the complete company name. For corporations, include divisions or subsidiary name, if any.

2. Source Name*

Provide the source name. Please note that a source 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 well site, tank battery, etc.).

4. Portable Source?*

YesNo

5. Temporary Source?*

YesNo

6. Existing Source*

YesNew Source - Add Date Below

If New Source, Date of Construction

Date

7. NAICS Code*

The NAICS Code for your source can be found at the following link: https://www.census.gov/naics/.

8. SIC Code*

Although the new NAICS code has replaced the SIC codes, much of the Clean Air Act permitting processes continue to use these codes. The SIC Code for your source can be found at the following link: http://www.osha.gov/pls/imis/sic_manual.html.

9. Physical Address (home base for potable sources). Provide the actual address of where the source is operating, not the mailing address.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Provide all locations of operation for portable sources on items 10-13.

10. Reservation*

Provide the name of the Indian reservation within which the source is operating.

11. County*

Provide the County within which the source is operating.

12a. Latitude*

These are GPS (global positioning system) coordinates. This information can be provided in decimal format or degree-minute-second format.

12b. Longitude*

These are GPS (global positioning system) coordinates. This information can be provided in decimal format or degree-minute-second format.

13a. Quarter-Quarter Section*

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

13b. Section*

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

13c. Township*

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

13d. Range*

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

B. CONTACT INFORMATION

1. Owner Name*

List the full name (last, middle initial, first) of all owners of the source.

Title*

Mailing Address*

Mailing Address

Street Address Line 2

CityState

Zip Code

Email Address*

example@example.com

Telephone Number*

Facsimile Number

2. Operator Name (if different than owner)

Title

Mailing Address

Street Address Line 2

CityState

Zip Code

Email Address

Telephone Number

Facsimile Number

3. Source Contact*

The source contact must be the local contact authorized to receive requests for data and information.

Title*

Mailing Address*

Mailing Address

Street Address Line 2

CityState

Zip Code

Email Address*

example@example.com

Telephone Number*

Facsimile Number

4. Compliance Contact*

The compliance contact must be the local contact responsible for the source’s compliance with this rule. If this is the same as the Source Contact please note this on the form.

Title*

Mailing Address*

Mailing Address

Street Address Line 2

CityState

Zip Code

Email Address*

example@example.com

Telephone Number*

Facsimile Number

C. ATTACHMENT

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

Please include all items in C as one attachment.*

1) Narrative description of the operations

2) Identification and description of all emission units and air pollution generating activities (with the exception of the exempt emissions units and activities listed in Minor Source Program Regulations, Section 201(C)).

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

4) Type and amount of each fuel used

5) Type raw materials used

6) Production Rates

7) Operating Schedules

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

9) Total allowable (potential to emit if there are no legally and practically enforceable restrictions) 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, 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.

10) 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.

11) Other

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.*

	Total Actual Emissions (tpy)	Total Allowable or Potential Emissions (TPY)
PM
PM10
PM2.5
SOx
NOx
CO
VOC
Pb
NH3
Flourides
H2SO4
H2S
TRS
RSC

The potential to emit includes fugitive emissions only if the source belongs to one of the source categories listed in 40 C.F.R. part 51, Appendix S, paragraph II.A.4(iii) or 40 C.F.R. § 52.21(b)(1)(iii), as applicable. Minor Source Program Regulations Section 102(B)(28).

(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.

1. Allowable Emissions (See also, Potential to Emit): Emissions rate of a source calculated using the maximum rated capacity of the source (unless the source is subject to practically and legally enforceable limits which restrict the operating rate, or hours of operation, or both) and the most stringent of the following:

a) Any applicable standards as set forth in 40 CFR parts 60 and 61;
b) Any applicable Tribal or Federal Implementation Plan emissions limitation, including those with a future compliance date; or
c) Any emissions rate specified as a federally enforceable permit condition, including those with a future compliance date.

2. Potential to Emit: The maximum capacity of a source to emit a pollutant under its physical and operational design. Any physical or operational limitation on the capacity of the source to emit a pollutant, including air pollution control equipment and restrictions on hours of operation or on the type or amount of material combusted, stored, or processed, shall be treated as part of its design if the limitation or the effect it would have on emissions is enforceable as a practical matter. See Allowable Emissions.

Actual Emissions: Estimates of actual emissions must take into account equipment, operating conditions, and air pollution control measures. For a source that operated during the entire calendar year preceding the initial registration submittal, the reported actual emissions typically should be the annual emissions for the preceding calendar year, 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. However, if you believe that the actual emissions in the preceding calendar year are not representative of the emissions that your source will actually emit in coming years, you may submit an estimate of projected actual emissions along with the actual emissions from
the preceding calendar year and the rationale for the projected actual emissions. For a source that has not operated for an entire year, the actual emissions are the estimated annual emissions for the current 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 Authority.

4. Guidance for estimating emissions can be found by searching for EPA's Tribal Minor New Source Review website at https://www.epa.gov/tribal-air/tribal-minor-nsr-registration-source-emissions-calculators.

NAVAJO NATION MINOR SOURCE PROGRAM

A. GENERAL SOURCE INFORMATION

B. CONTACT INFORMATION

C. ATTACHMENT

D. TABLE OF ESTIMATED EMISSIONS