Alaska Department of Environmental Conservation
                 Air Quality Control Minor Permit Application
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            MINOR PERMIT APPLICATION  -  EMISSION UNIT INFORMATION
FOR A NEW STATIONARY SOURCE:  Complete this form for all emissions units.
	
FOR A MODIFICATION TO AN EXISTING STATIONARY SOURCE:
IF YOU HAVE A TITLE V PERMIT:  Complete this form for each emissions unit that is new or that is affected by a physical change or change in the
            method of operation.
IF YOU DO NOT HAVE A TITLE V PERMIT or APPLICATION CLASSIFIED UNDER 18 AAC 50.508(5): Complete this form for all emissions units.

    Section 1     Stationary Source Information

Stationary Source Name:          


Section 2     Emissions Unit (EU) Identification (ID) and Description
Note: Do not use this section for emission units associated with asphalt plants, soil remediation, and rock crushers. Use the Supplementary Forms for these units.
                                   EU ID No.
                                  Description
                               Construction Date
                                 Make / Model
                                  Serial No.
                       Requested Limit* 
(specify units)
    Max. Rated Capacity (kW, MMBtu), Horsepower (hp) or. Design Throughput
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
*If no annual limit is applicable (e.g., hours, fuel), then specify not applicable (N/A).
Please use additional copies of this sheet if necessary.
        
        Have you identified each emission unit (if you do not have a Title V permit), or each new or affected emission unit (if you have an existing Title V permit) in Section 2 above?   Yes      No 
If not, please explain: 
        
          
Section 3     Emissions Unit Use
                                   EU ID No.
                               Is unit portable?
                                 Is the unit:
                                Is this unit a:
                      If limited operation, is the unit:
                       [List same EUs as in Section 2.]
                                   Yes    No
                               a nonroad engine?
                                       
                                   Yes    No
   an intermittently used oil field support equipment per Policy 04.02.105?
                           Yes                   No
             an oil field construction unit per Policy 04.02.104?
                              Yes             No
                           primary (base load) unit?
                          or limited operation unit?
                        emergency or black start unit?
                                       
                          subject to a permit limit?
                             or  other (specify)?
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
                                          
                                          
                                           
                                                 
                                              
                                       
                                       
                                       
                                       
                                           
Please use additional copies of this sheet if necessary.

        
        Have you specified the use of each emission unit in Section 3 above?   Yes      No 
If not, please explain: 

          

Section 4     Fuel Information 
Complete Section 4a or 4b for each emissions unit, as appropriate. 
Section 4a   Fuel Burning Equipment not Including Flares
                                   EU ID No.
                                 Fuel type(s)
                          Maximum fuel sulfur content
                             Fuel density (lb/gal)
                               (if liquid fuel)
                             Higher heating value*
          Maximum fuel consumption rate (gallons/hour or MMscf/hour)
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
                                          
                                          
                                  wt. % S     ppmv H2S
                                          
                      Btu/gal   Btu/dscf              Other
                                          
*Use British thermal unit (Btu) per gallon (gal) for liquid fuels.  Use Btu per dry standard cubic foot (dscf) for gaseous fuels. 
Please use additional copies of this sheet if necessary.


        Have you provided the fuel details for each fuel-burning emission unit (excluding flares) in Section 4a above?  Yes      No 
If not, please explain: 
        
          


Section 4b   Flares
Complete this section if the project/stationary source contains a flare. 
Do you own or operate a flare?  Yes      No (If not skip this section)
                                   EU ID No:
           Heat release rate for pilot / purge operation (MMBtu/hr)
                     Maximum heat release rate (MMBtu/hr)
                       Flare gas heat content (Btu/scf)
                         Flare gas H2S content (ppmv)
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
Please use additional copies of this sheet if necessary

Include additional notes as warranted.
          

        Have you provided the fuel use details for all flares in Section 4b above?   Yes      No 
If not, please explain: 
        
          

Section 5 	Materials Processed and Methods of Operation
Complete this section if the project/stationary source contains a materials-handling process. 
Do you own or operate a flare?  Yes      No (If not, skip this section)
                                   EU ID No.
                              Materials processed
                       Maximum material processing rate
                         Describe method of operation
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
Please use additional copies of this sheet if necessary

Include additional notes as warranted.
          

         Have you specified the material processing details in Section 5 above?   Yes      No 
If not, please explain:
         
          
         

Section 6     Emission Control Information (if applicable)
Complete this section if the project/stationary source contains emission control equipment.   
Do you own or operate emission control equipment?  Yes      No (If not, note below and skip this section.)
                                   EU ID No.
                               Control equipment
                           Pollutant(s) controlled:
                     Description of the control equipment
Description of significant operating parameters and set points for the control equipment
                      The control equipment is necessary:
                                       
                                       
                                       
                                       
                                       
                      To comply with an emission standard
                       To avoid a project classification
                  Other  -  give purpose of control equipment
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
                                          
                                          
                                          
                                          
                                          
                                       
                                       
                                          
Please use additional copies of this sheet if necessary

Include additional notes as warranted.
          

         Have you specified the details of any emission controls in Section 6 above?   Yes      No 
If not, please explain:
         
          
         
 Section 7     Emission Factors 
 Give exact citations of emission factor sources. 
                                   EU ID No.
                               Emission Factors
                                       
                                      NOx
                                      CO
                                    PM-2.5
                                     PM-10
                                      PM
                                      SO2
                                      VOC
                                     HAPs
                                     Lead
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          


                                   EU ID No.
                  Sources and References for Emission Factors
                                       
                                      NOx
                                      CO
                                    PM-2.5
                                     PM-10
                                      PM
                                      SO2
                                      VOC
                                     HAPs
                                     Lead
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                       
Please use additional copies of this sheet if necessary.


Include additional notes as warranted.
          
  
              Have you specified all emission factors and reference sources in Section 7 above?   Yes      No 
If not, please explain:
  
          
         
         
         
Section 8     Applicable State Emission Limits (listed in 18 AAC 50.050 through 18 AAC 50.090)
Complete this section for emissions units that are new or are affected by the physical change or change in operation.

EU ID No.
                          Emission Limit or Standard
                              Regulation Citation
                               Compliance Method
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
          
Please use additional copies of this sheet if necessary.


         Have you specified all applicable state emission limits in Section 8 above?                           Yes      No 
Have you specified a demonstration of compliance for each emission limit or standard?     Yes      No
         If you answered "no" to either question, please explain:

          
         












Section 9   Incinerators 

Complete this section if the project/stationary source contains an incinerator. 
Do you own or operate an incinerator?  Yes      No (If not, skip this section.)



EU ID No.
                   Fuels Burned 
(type and consumption rate)
                       Rated capacity in pounds per hour
                             Type of waste burned
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
                                          
Please use additional copies of this sheet if necessary

Include additional notes as warranted.
          

         Have you specified the details of all incinerators in Section 9 above?   Yes      No 
If not, please explain:

          
         
