                Alaska Department of Environmental Conservation
                 Air Quality Control Minor Permit Application
                                       

                            EMISSIONS SUMMARY FORM
                             NEW STATIONARY SOURCE
Section 1     Stationary Source Information
Stationary Source Name:           
                                   EU ID No.
                                   PTE (tpy)
                                       
                                      CO
                                    NOX[4]
                                   PM-2.5[1]
                                   PM-10[1]
                                      PM
                                      SO2
                                    VOC[2]
                                Fugitive VOC[3]
                                Fugitive PM[3]
                                     Lead
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                   Total tpy
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          

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

 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: 
		
          

