                OMB No. 2060-0336, Approval Expires 06/30/2015

Federal Operating Permit Program (40 CFR Part 71)

ANNUAL COMPLIANCE CERTIFICATION (A-COMP)



A.  GENERAL INFORMATION  

Permit No. ____________________    

Reporting Period: Beg.____/____/________  End.____/____/_______

Source / Company Name
___________________________________________________________

Mailing Address:  Street or P.O. Box
________________________________________________

City ________________________________________   State______   
ZIP__________ - ______

Contact person __________________________________     Title
___________________________

         

Telephone (______) ______ - __________ Ext. ________    





Continued on next page

B.  COMPLIANCE STATUS

Describe the compliance status of each permit term for the reporting
period.  Copy this page as many times as necessary to cover all permit
terms and conditions.

Emission Unit ID(s):

Permit Term (Describe requirements and cross-reference)

Compliance Methods for the Above (Description and Citation):

Status (Check one):  ___ Intermittent Compliance     ___ Continuous
Compliance





Emission Unit ID(s):

Permit Term (Describe requirements and cross-reference)

Compliance Methods for the Above (Description and Citation):

Status (Check one):  ___ Intermittent Compliance     ___ Continuous
Compliance





Emission Unit ID(s):

Permit Term (Describe requirements and cross-reference)

Compliance Methods for the Above (Description and Citation):

Status (Check one):  ___ Intermittent Compliance     ___ Continuous
Compliance





Emission Unit ID(s):

Permit Term (Describe requirements and cross-reference)

Compliance Methods for the Above (Description and Citation):

Status (Check one):  ___ Intermittent Compliance     ___ Continuous
Compliance





C.  

DEVIATIONS FROM PERMIT TERMS AND CONDITIONS

 

Report all deviations from permit terms (whether reported previously or
not) that occurred during the permit term.  Cross-reference deviations
already reported in the six-month report.  Indicate whether each
deviation is a (possible exception( to compliance.(  Start and end
period of each deviation should be in mo/day/yr, hr:min format (24-hour
clock).  Also specify the date when the written deviation report was
submitted (If written report required, but not submitted, leave the date
field blank). 

Permit Term for Which There was a Deviation:

Emission Units (unit IDs):

Deviation Start _____/_____/_________   ____:____   
End:_____/_____/_________   ____:____

Date Written Report Submitted ____/____/________  





Permit Term for Which There was a Deviation:

Emission Units (unit IDs):

Deviation Start _____/_____/_________   ____:____   
End:_____/_____/_________   ____:____

Date Written Report Submitted ____/____/________





Permit Term for Which There was a Deviation:

Emission Units (unit IDs):

Deviation Start _____/_____/_________   ____:____   
End:_____/_____/_________   ____:____

Date Written Report Submitted ____/____/________





Permit Term for Which There was a Deviation:

Emission Units (unit IDs):

Deviation Start _____/_____/_________   ____:____   
End:_____/_____/_________   ____:____

Date Written Report Submitted ____/____/________





INSTRUCTIONS FOR A-COMP

ANNUAL COMPLIANCE CERTIFICATION

  SEQ CHAPTER \h \r 1 Information Collection Burden Estimates

The public reporting and recordkeeping burden for this collection of
information is estimated to average 221 hours per respondent per year. 
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.

DETAILED INSTRUCTIONS

Submit this form along with a certification of truth, accuracy and
completeness by a responsible official on an annual basis.

Section A (General Information)

Name and address should be consistent with information provided
previously.  The contact person should be a person familiar with the
day-to-day operation of the facility, such as a plant site manager or
other individual, who should be available to be contacted by the
permitting authority.  If there is more than one contact person, list
the others on an attachment.

The reporting period must be at least every 12 months, but your permit
may require this more frequently.

Section B (Compliance Status)

Description of Permit Term:  Include each permit terms that imposes a
requirement or action (emission limitations, standards, monitoring,
recordkeeping, reporting, and other requirements on one or more emission
units or on the facility.  You will likely have to complete this section
numerous times to include all requirements in the permit.  

The emissions unit ID(s) should be those defined in the permit or in
section I of form GIS.  If the requirements, including compliance
methods, apply in the same way to multiple emission units, you may list
multiple units for a particular requirement.  Emission units and
requirements may be grouped if they apply the same way at all units in
the group, the same compliance methods apply to all, and all units have
the same compliance status.

Citations to the requirements should unambiguously identify the permit
term to the lowest level. 

Compliance Methods:  List all compliance methods (monitoring,
recordkeeping and reporting) you used to determine compliance with the
permit term described above.  Also describe and cross-reference these
compliance methods.

To describe monitoring, indicate the monitoring device, what is being
monitored, averaging time, frequency, and cross-reference the permit
term.  To describe recordkeeping, describe the records kept, collection
frequency, and cross-reference the permit term.  Please indicate whether
monitoring data, results, or if compliance records are be kept on-site
rather than reported.  To describe reporting requirements, describe what
is reported, when it is reported, and cross-reference the permit term.

The citation or cross-reference here must unambiguously identify the
requirement to the lowest level. 

Compliance Status:  For each permit requirement and its associated
compliance methods, indicate whether there was intermittent or
continuous compliance (check one) during the reporting period.  You
should consider all available information or knowledge that you have
when evaluating this, including compliance methods required by the
permit and (credible evidence( (e.g., non-reference test methods and
information (readily available( to you).  You are always free to include
written explanations and other information to clarify your conclusion
regarding compliance status.  

 

You must include permit terms that were not effective or not applicable
(e.g., future-effective requirements, compliance options, and
alternative scenarios).  You may certify to continuous compliance for
these if there is no evidence of noncompliance.

Absent evidence to the contrary, you may certify continuous compliance
based on the data provided by the compliance methods, provided you did
not fail to perform them and there were no unexcused deviations.  Any
failure to meet any permit term for any period of time indicates
intermittent compliance.  You may also indicate “undetermined
compliance,” if you include the reason.

Section C (Deviations From Permit Terms and Conditions)

Summarize all deviations from permit terms that occurred since the last
compliance certification.  They may have been reported previously
in-writing or they may be reported concurrently with this certification.
Also include any deviations but have not yet been reported in writing.

Copy this page as many times as necessary to include all deviations that
occurred during the reporting period for this compliance certification.

Deviations occur when any permit term is not met, including emission
limitations, standards, monitoring, recordkeeping, reporting and other
requirements.  For a more detailed explanation of the term (deviation,(
see the instructions for Form SIXMON.  A deviation is not necessarily a
violation.  Violations are determined by EPA (or its delegate Agency).

You may cross-reference deviations previously reported (e.g., in 6-month
monitoring reports).

You must indicate whether each deviation is a (possible exception to
compliance.(  This is a deviation that occurs when compliance is
required.   A deviation that is not a “possible exception to
compliance” is one that occurs when compliance is not required or it
is excused by another permit term.  If you indicate that a deviation is
not a possible exception to compliance, briefly explain and
cross-reference the permit term that allows or excuses it.  Also,
deviations for which the permit provides an affirmative defense (e.g.,
emergencies) must be identified as “possible exception to
compliance” because only the permitting authority may determine if the
affirmative defense applies.

If the cross-reference a deviation report that does not contain all the
information requested here, you must supplement it accordingly.  

 

You may list multiple emission units if they all had the same deviation
during the same time periods.  In addition, for deviations that impose
requirements to the permitted facility as a whole or to all units at
your facility, you may enter (facility-wide( in the emissions unit
column. 

You may indicate continuous periods of deviation that span multiple days
in a single entry.  Use the 24-hour clock (equivalent to military time)
for reporting these times (e.g., the day starts and ends at midnight, 12
a.m., or 00:00 in military time.

Specify the date when the written deviation report was submitted to the
permitting authority.  Leave the date field blank if you did not submit
a written deviation report during the reporting period covered by the
six-month monitoring report (whether required to do so or not).  It is a
deviation to fail to submit a required deviation report.

Form CTAC (Certification of Truth, Accuracy, and Completeness by
Responsible Official) 

You must complete form CTAC and attach it to this annual compliance
certification. 

 PAGE  6 

A-COMP	

      EPA Form 5900-04

         EPA Form 5900-04

