                Alaska Department of Environmental Conservation
                 Air Quality Control Minor Permit Application
                                       

                            EMISSIONS SUMMARY FORM
                 Modification of an Existing Stationary Source
	
Section 1     Stationary Source Information
Stationary Source Name:           

Section 2     Existing Potential to Emit (PTE) for the Entire Stationary Source BEFORE the Modification 

                                   EU ID No.
                    Does project affect the emissions unit?
                                   PTE (tpy)
                                       
                                       
                                       
                                      CO 
                                    NOx[4]
                                   PM-2.5[1]
                                   PM-10[1]
                                      PM
                                      SO2
                                    VOC[2]
                                Fugitive VOC[3]
                                Fugitive PM[3]
                                          
                               Yes             No
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                               Yes             No
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                               Yes             No
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                               Yes             No
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                               Yes             No
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                               Yes             No
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                               Yes             No
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                           Total tons per year (tpy)
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
 Detailed Excel spreadsheet emissions calculations are attached.   These must be attached in order for your application to be complete.  
Include multiple copies of this page if more space is required.

   Check this box if fugitive emissions are included in permit applicability under 18 AAC 50.502(i).
Brief description of why fugitive emissions are included in permit applicability:           
Notes:
[1]	Include condensable particulate matter for PM-10 and PM-2.5.
[2]	If total PTE for volatile organic compounds (VOCs) is at least 10 tpy, include a separate Excel spreadsheet that shows the HAP emissions.  
[3]	Fugitive VOC and PM emissions are included as assessable emissions regardless of permit applicability. 
[4]	Fugitive NOx emissions from blasting should be included in the PTE column for NOx.

           Have you completed Section 2 above?   Yes      No 
If not, please explain: 
           
          
           
Section 3    Change in Emissions

Show ONLY existing emissions units that are affected by the project. Show EITHER the change in actual emissions (Sections 3a and 3b) 
OR the change in potential emissions (Sections 2 and 3c). 

Section 3a    Actual Emissions  -  NOx, CO, PM-2.5, PM-10, PM, SO2      (18 AAC 50.502(c)(3)(B) or 18 AAC 50.508(5))

If an existing emissions unit is being removed, enter zero for "projected actual emissions" for that unit.

See 18 AAC 50.502 for directions on calculating "baseline actual emissions" and "projected actual emissions."

                                   EU ID No.
                             Type of Modification
                        Baseline Actual Emissions (tpy)
                       Projected Actual Emissions (tpy)
                                       
                                  Modified EU
                                  Removed EU
                                      CO
                                      NOX
                                   PM-2.5[1]
                                   PM-10[1]
                                      SO2
                                      CO
                                      NOX
                                   PM-2.5[1]
                                   PM-10[1]
                                      SO2
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                       
                                       
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                    Total 
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
Use this table only if the project does not include new emission units. See 18 AAC 50.502(e) and (h)(4)

 Detailed Excel spreadsheets emissions calculations are attached.   These must be attached in order for your application to be complete.  You may give an example calculation where the method of calculation is identical for multiple emissions units.
Notes:
[1] 	Include condensable particulate matter for PM-10 and PM-2.5.






Section 3b   Change in Actual Emissions   (18 AAC 50.502(c)(3)(B) or 18 AAC 50.502(c)(4)(B))

If you choose actual emissions as your basis, complete Sections 3a and 3b for each emissions unit for which you answered "YES" in Section 2.  
Change in actual emissions = "projected actual emissions" minus "baseline actual emissions" from Section 3a.

                                   EU ID No.
                       Change in Actual Emissions (tpy)
                                       
                                      CO
                                      NOx
                                   PM-2.5[1]
                                   PM-10[1]
                                      SO2
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                     Total
                                          
                                          
                                          
                                          
                                          

Use this table only if the project does not include new emission units. See 18 AAC 50.502(e) and (h)(4)
[1]	 Include condensable particulate matter for PM-10 and PM-2.5.

           Have you completed Section 3a and 3b above?   Yes      No 
If not, please explain: 

          












Section 3c     Change in Potential to Emit (PTE)    (18 AAC 50.502(c)(3)(A) or 18 AAC 50.502(c)(4)(A))

If you choose PTE as your basis for calculation, complete this section for each emissions unit that is new and for each emissions unit for which you answered "YES" in Section 2.  

Under "PTE AFTER the Modification", enter zero if you are removing the emissions unit. 

Under "Change in PTE": 
For each EXISTING emissions unit, subtract the amount of PTE BEFORE Modification in Section 2 from the "PTE AFTER the Modification" 
For each NEW emissions unit, enter the amount from "PTE AFTER the Modification."

                                   EU ID No.
                      PTE - AFTER the Modification (tpy)
[only from modified and new emissions units. Do not list emission units for which you answered "NO" in Section 2.] 
                                       
                              Change in PTE (tpy)
                                       
                                       
                                      CO
                                      NOX
                                   PM-2.5[1]
                                   PM-10[1]
                                      PM
                                      SO2
                                      VOC
                                    HAPs[2]
                                      CO
                                      NOX
                                   PM-2.5[1]
                                   PM-10[1]
                                      PM
                                      SO2
                                      VOC
                                     HAPs
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                     Total
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                  Source-Wide
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          

Include multiple copies of this page if more space is required.
 Detailed Excel spreadsheet emissions calculations are attached.   These must be attached for your application to be complete.
Notes:
[1] 	Include condensable particulate matter for PM-10 and PM-2.5
[2] 	If the total PTE for hazardous air pollutants (HAPs) for the entire stationary source is at least 10 tpy, include a separate Excel spreadsheet that shows the HAP emissions.

           Have you completed all portions of Section 3c above?   Yes      No 
If not, please explain: 

          

