Alaska Department of Environmental Conservation
                 Air Quality Control Minor Permit Application
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            MINOR PERMIT APPLICATION  -  EMISSION UNIT INFORMATION 
SUPPLEMENTARY FORMS FOR ASPHALT PLANTS, SOIL REMEDIATION UNITS & ROCK CRUSHERS
                                       
FOR A NEW STATIONARY SOURCE:  Complete this form for all emission 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 the project.
IF YOU DO NOT HAVE A TITLE V PERMIT: Complete this form for all emissions units.
                                       
                                       
Section 1     Stationary Source Information
Stationary Source Name:           

Owner/Operator:                        
Physical Address:                      
City and Zip Code:                    


Asphalt Plants (Section 2)

Soil Remediation (Section 3)

Rock Crusher (Section 4)          


           Have you completed Section 1, above?   Yes      No 
If not, please explain: 
           
          
           

Section 2:  Asphalt Plant
If the stationary source contains an asphalt plant(s), complete this section instead of Section 2 of Emission Unit Information Form.
Type of Equipment
Make and Model
Primary burner size
(Btu per hour)
Plants Production Rate 
(maximum and rated)
Maximum Fuel Feed Rate:
Gallon/hr    Scf/hr
Dryer:
          
          
          
          
Afterburner :
          
          
          
          
Dryer:
          
          
          
          
Afterburner :
          
          
          
          
Identify each piece of installed equipment by placing an "x" in the box beside the piece of equipment. If the equipment listed has a place to provide the size and capacity, provide that additional information. List only diesel engines that are stationary.
Material handling devices:     
Conveyors,                                
Loaders, 
Bins,
Elevators,                                        
Screens, or                                  
Chutes
Dryer control devices:
    Baghouse
    Cyclone 
    Scrubber
    Knockout box
Any of the following:
    Asphalt cement heaters,
    Fuel fired silo heaters
    Mixers
    Pug mills
    Other emission control equipment.  List:
                    
                    
Diesel engines:
    Make & model           ,  Size           hp,  Max fuel rate          gal/hr
    Make & model           ,  Size           hp,  Max fuel rate          gal/hr
    Make & model           ,  Size           hp,  Max fuel rate          gal/hr
Nearest distance from dryer exhaust outlet to:
 Residence                                    miles
 Other occupied structure             miles
            Building use:           
Was the asphalt plant constructed, modified, or reconstructed before June 11, 1973? If so, check appropriate box.
    Constructed
    Modified
    Reconstructed
If requested by the Department:
  Attached is a copy of the operation and maintenance plan for the unit.
  Attached is 
        a copy of the most recent particulate matter source test conducted within the last five years; or
        a schedule for conducting the test.
   For an asphalt plant within one mile of the nearest residence or occupied structure, a fugitive dust control plan is attached.

           Have you completed Section 2, above?   Yes      No 
If not, please explain: 
           
          
           

Section 3:   Soil Remediation Unit
If the stationary source contains a soil remediation unit(s), complete this section instead of Section 2 of Emission Unit Information Form.
Type of Equipment
Make and model
Plants Production Rate 
(maximum and rated)
Maximum fuel feed:
Gallon/hr            Scf/hr
Dryer, rotary kiln, combustion device in fluidized bed, etc.:
          
          
          
Afterburner :
          
          
          
Dryer, rotary kiln, combustion device in fluidized bed, etc.:
          
          
          
Afterburner :
          
          
          
Identify each piece of installed equipment by placing an "x" in the box beside the piece of equipment. If the equipment listed has a place to provide the size and capacity, provide that additional information. List only diesel engines that are stationary.
Material handling devices:     
Conveyors,                                
Loaders, 
Bins,
Elevators,                                        
Screens, or                                  
Chutes

Dryer control devices:
    Baghouse
    Cyclone 
    Scrubber
    Knockout box
    Other emission control equipment.  List:
                    
                    
                    
 Diesel engines:
    Make & model           ,  Size           hp,  Max fuel rate          gal/hr
    Make & model           ,  Size           hp,  Max fuel rate          gal/hr
    Make & model           ,  Size           hp,  Max fuel rate          gal/hr
 Storage areas for 
     Untreated soils  (Describe)                                
          If storage bin provide the date installed:           
     Treated soils  (Describe)                                     
          If storage bin provide the date installed:           
      Enclosed truck loading station                   Date Installed:             
      Railcar loading station                               Date Installed:             
    
Nearest distance from emission unit outlet to:
      Residence                                    miles
      Other occupied structure             miles
              Building Use:            
   Attached is a VOC and dust control plan.

   Attached is a carbon monoxide continuous emission monitor performance test report, or schedule for conducting the test. 


If requested by the Department:

  Attached is a copy of the operation and maintenance plan for the unit.
  Attached is 
     a copy of the most recent particulate matter source test if conducted within the last five years; or
     a schedule for conducting the particulate matter source test.
    


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


Section 4   Rock Crushers
If the stationary source contains a rock crusher(s), complete this section for emission units related to rock crushing.
Initial Crushers

Other Crushers
Equipment ID.
Rated capacity (tons per hour

Equipment ID.
Rated capacity (tons per hour)
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          

Other Grinding Mills

Screening Operations
Equipment ID.
Rated capacity (tons per hour)

Equipment ID.
Rated capacity (tons per hour)
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          





Belt Conveyors

Belt Conveyors
Equipment ID.
Rated capacity (tons per hour)

Equipment ID.
Rated capacity (tons per hour)
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          




Bucket Elevators

Storage Bins
Equipment ID.
Rated capacity (tons per hour)

Equipment ID.
Rated capacity (tons per hour)
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          
          
          

          
          





Bagging Operations

Enclosed Truck or Railcar Loading Stations
Equipment ID.
Rated capacity (tons per hour)

Equipment ID.
Rated capacity (tons per hour)
          
          

          
          
          
          

          
          


Nearest distance from equipment listed above to:
      Residence                                    miles 
      Other occupied structure             miles
              Building Use:           
If requested by the Department:

   For a rock crusher, a fugitive dust control plan is attached.


NOTE:  Rock crushers and asphalt plants may be subject to federal New Source Performance Standards (40 C.F.R. 60, Subparts I, LL, and OOO.)  The Department no longer enforces these standards through air quality minor permits.   Address all correspondence about compliance with these standards to EPA.

           Have you completed Section 4, above?   Yes      No 
If not, please explain: 
           
          
           
