## DEPARTMENT OF ENVIRONMENTAL

CONSERVATION

Standard Permit Condition XVI

– Emission Inventory

Reporting Form

Permit Condition for Air Quality Permits

Adopted by Reference in 18 AAC 50.346

September 27, 2010Standard Permit Condition XVI

– Emission Inventory Reporting Form September 27, 2010

2 

## ADEC Reporting Form

Emission Inventory Reporting

State of Alaska Department of Environmental Conservation

Division of Air Quality 

# Emission Inventory Year

- [ ]

Mandatory information is highlighted.

Inventory start

date:

Inventory end date:

Inventory Type:



### Facility Information:

ADEC Stationary Source ID:

(Stationary Source) Facility

Name :

AFS ID:

Census Area/ Community:

Line of Business (NAICS ):

Contact/Owner Name:

Contact Owner Address:

Contact/Owner Phone

Number:

Facility Physical Address:

Lat: Long:

Mailing Address :



### Emission Unit:

ID:

Description:

Manufacturer:

Model Number:

Serial Number:

Year of Manufacture:

Maximum Nameplate

Capacity:

Design Capacity (BTU/hr):

Control Equipment (List

All):

Control Equipment Type(Primary or Secondary):

ID:

Type:

Manufacturer:

Model:

Control Efficiency ( %):Standard Permit Condition XVI

– Emission Inventory Reporting Form September 27, 2010

3 Capture Efficiency ( %):

Total Capture Efficiency ( %):

Pollutants Controlled

-

-

-

-

Processes (List

All):

PROCESS:

SCC Code:

Material Processed:

Operational Periods:

FUEL INFORMATION

Ash Content (weight %):

Elem. Sulfur Content (weight %):

H2S Sulfur Content (ppmv):

Heat Content (MMBtu/1000 gal or MMBtu/MMscf):

Heat Input (MMBtu/hr):

Heat Output (MMBtu/hr):

THROUGHPUT

Total Amount:

Summer %:

Fall %:

Winter %:

Spring %:

Days/Week of Operation:

Weeks/Year of Operation:

Hours/Day of Operation:

Hours/Year of Operation:Standard Permit Condition XVI

– Emission Inventory Reporting Form September 27, 2010

4 EMISSIONS

Pollutant Emission

Factor Emission

Factor

Numerator Emission

Factor

Denominator Emission

Factor

Source Tons

Emitted

CO

NH3

NOX

PM10

- PRI

PM25

- PRI

SO2

VOC

Lead and lead

compounds

Stack

Description:

Stack Detail:

ID:

Type:

Measurement Units:

Base Elevation:

Stack Height:

Stack Diameter:

Exit Gas Temp:

Exit Gas Velocity:

Actual Exit Gas Flow Rate:

Data Source:

Description:

Latitude:

Longitude:

Location Description:

Accuracy (m):

Datum:

Certification:

Based on information and belief formed after reasonable inquiry, I certify that the statements and

information in and attached to this document are true, accurate, and complete.

Printed Name:______________________________Title_____________________Date ______

Signature:_________________________________ Phone number_______________________Standard Permit Condition XVI

– Emission Inventory Reporting Form September 27, 2010

5 

### NOTE: This document must be certified in accordance with 18 AAC 50.345(j)



### To Submit this report :

1. Fax this form to: 907

- 465

- 5129

Or

2. E

- mail to : DEC.AQ.airreports@alaska.gov

Or

3. Mail to: ADEC

Air Permits Program

410 Willoughby Ave., Suite 303

PO Box 111800

Juneau , AK 99801

- 1800

Or

4 . Submission of information can be made via a full electronic batch submittal (XML files)

. This will require each data element to be tagged with XML ( Extensible Markup Language)

code before it can be uploaded to ADEC database.

https://myalaska.state.ak.us/dec/air/airtoolsweb/EiXmlValidator.aspx