Air Permit Applicability Questionnaire

Air Permit Applicability Questionnaire
Full Name*

First NameLast Name
E-mail*
Phone Number

Area CodePhone Number
Facility Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Facility Name*
General Description of Business
Combustion Sources
Does the facility have any combustion sources?*

YesNo
Does the facility operate any of the following combustion sources?

Generator(s)Boiler(s)Other types of combustion equipment (i.e., process heaters, process ovens, water heaters, etc.)
Generator
Make and Model
Generator Use (i.e., emergency, peak shaving, etc.)
Fuel Type
Maximum Rated Capacity
Units

hpkW
Date of Installation
Attach Manufacturer's Specifications (if available)

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Boiler
Make and Model
Maximum Rated Capacity (MMBtu/hr)
Fuel Type
Date of Installation
Attach Manufacturer's Specifications (if available)

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Other
Is equipment used for comfort heat?

YesNo
Description of Equipment
Maximum Rated Capacity (MMBtu/hr)
Fuel Type
Attach Manufacturer's Specifications (if available)

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Storage Tanks
Does the facility have storage tanks?*

YesNo
Type of Tank

Above groundUnderground
Tank Storage Capacity (gallons)
Product Being Stored?
Vapor Pressure of Product Being Stored (psia) (if available)
Date of Installation
Portable Crushers
Does the facility own and operate a portable crusher?*

YesNo
Make and Model
Maximum Rated Capacity (tons/hr)
Date of Installation
Is the Power Source a Generator?

YesNo
Generator Make and Model
Generator's Rated Capacity
Units

hpkW
Generator Fuel Type
Attach Manufacturer's Specifications (if available)

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VOC Sources
Do facility operations involve coating, printing or operating a paint booth?*

YesNo
Attach MSDS of the coating with the highest VOC content (if available)

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List the highest VOC content of the coating (lbs/gal) - found on MSDS
Facility's projected operating hours
Do you have five (5) years of actual coating/paint usage? If so, please attach usage data

YesNo
If yes, please attach usage data

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What is the maximum number of units that can be coated/painted in an hour?
How many gallons of coating/paint is used per unit?
Do facility operations involve parts washing?*

YesNo
Is parts washing used for maintenance purposes only?

YesNo
Name of solvent used
Attach MSDS of the solvent with the highest VOC content (if available)

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List the highest VOC content (lbs/gal)
Potential amount of solvent used annually (gallons)
Abrasive Blasting
Does the facility perform abrasive blasting?*

YesNo
Do emissions vent outdoors?

YesNo
Maximum rated capacity of equipment (lbs/hr)
Facility's projected operating hours
Percent of material routed to a control device (if applicable)
Stage 1 Facility
Does the facility have gasoline dispensing?*

YesNo
What is the projected annual gasoline throughput?
Storage Silos
Does the facility have storage silos controlled by a baghouse?*

YesNo
What type of material is being stored?
Provide potential emissions from the storage silo(s) in tons per year (potential emissions are based on the facility operating 8,760 hours/year)
Attach Emission Calculations

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Other
Does the facility have any other emission sources that vent to the outdoor atmosphere?*

YesNo
Emission Source Description
Provide potential emissions from that source in tons per year (potential emissions are based on the facility operating 8,760 hours/year)
Attach Emission Calculations and/or Supporting Documentation

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Should be Empty:

Air Permit Applicability Questionnaire

Combustion Sources

Storage Tanks

Portable Crushers

VOC Sources

Abrasive Blasting

Stage 1 Facility

Storage Silos

Other