FORM A-1

COMPANY INFORMATION

I. Parent Company / Legal Corporate Owner Information

1. Legal Parent Company / Legal Corporate Name

2. Mailing Address

3. City

4. State

5. Zip Code

6. County

7. Size of Company (approximate number of employees 

including all subsidiaries, branches, and related 

establishments owned):

Page 1 of 1

DRAFT PVC Section 114 Survey Part 1

06/23/2009
FORM A-2

FACILITY INFORMATION

II. Polyvinyl Chloride and Copolymers (PVC) Production Facility Information

1. Facility Name

Facility Address

a. Street

b. City

c. State

d. Zip Code

e. County

Facility Coordinates (Decimal Degrees to the 5th decimal place)

f. Latitude

g. Longitude

2. Number of employees attached to the PVC 

production facility:

III. Technical Contact

1. Name

2. Technical Contact Title

3. Telephone

4. Facsimile

5. Email

IV. Other

1. Is the facility a major source of HAP?

2. If No, did the facility take a limit of its 

potential HAP emissions to avoid classification 

as a major source?

3. If the facility took a limit of its potential HAP 

emissions to avoid classification as a major 

source, provide the date on which the limit was 

taken (MM/DD/YYYY).

4. Does the facility manufacture other products 

in addition to PVC resin?

5. If Yes, list the other products manufactured 

at the facility.

6. Are there any HAP emissions associated 

with any co-located facilities?

Page 1 of 1

DRAFT PVC Section 114 Survey Part 1

06/23/2009
FORM F-1

CONTROL DEVICES - ABSORBER

Instructions

1. Complete the form for each absorber used as a control device within the PVC production facility, or for any absorber that emits directly to atmosphere.

2. Refer to "Enclosure 1" for additional instructions and details.

1 Type of Equipment or Device

2 Equipment of Device ID

3 Type of Absorber

4 If other, provide a description:

5 Gas inlet flow rate (dscfm):

6 Gas inlet temperature (°F):

7 Pressure drop (in H2O):

8 Liquid-to-gas ratio (gal/103

 acfm):

Inlet scrubbing liquor

9 Liquor used:

10 pH:

11 Percent solids:

12 Type of alkali added, if any:

13 Addition rate (lb/gal):

14 Wastewater generation rate (gal/min):

15 Year Equipment Installed:

16 Equipment Currently Regulated Under (cite regulations):

Page 1 of 1

DRAFT PVC Section 114 Survey Part 1

06/23/2009
FORM F-2

CONTROL DEVICES - THERMAL OR CATALYTIC OXIDIZER

1 Control Device ID:

2 Number of operating hours per year (hours/year):

3 Is this emergency equipment?

4 Type (Thermal Oxidizer or Catalytic Oxidizer)

5 Oxidizer Inlet Flow Rate (dscfm):

6 Average percentage of total flow originating from the production facility:

7

Combustion chamber temperature (°F): (please note if temperature 

measurement is not in chamber)

8 Excess air (%):

9 Nominal residence time (s):

Heat recovery

10 Recuperative, percent heat recovery

11 Regenerative, percent heat recovery

12 Design Capacity (Heat Input) (MMBtu/hr):

13 Fuel Basis for Design Capacity:

14 Heat Release Rate (Btu/scf):

15 Is the unit subject to NSPS?

16 If yes, indicate the year:

Start-up Fuel/Material

17 Start-up fuel:

18 Number of start-ups per year:

19 Typical length of time for start-up (hours):

20 Higher heating value (HHV):

Fuels/Materials Combusted During Normal Operations (include solid, liquid, and gas waste streams)

21 Fuel 1:

22 Hours used per year:

23 Higher heating value (HHV):

24 Fuel 2:

25 Hours used per year:

26 Higher heating value (HHV):

27 Fuel 3:

28 Hours used per year:

29 Higher heating value (HHV):

30 Fuel 4:

31 Hours used per year:

32 Higher heating value (HHV):

33 Fuel 5:

34 Hours used per year:

35 Higher heating value (HHV):

36 Year Equipment Installed:

37 Equipment Currently Regulated Under (cite regulations):

Page 1 of 1

DRAFT PVC Section 114 Survey Part 1

06/23/2009
FORM F-3

CONTROL DEVICES - CONDENSERS

Instructions

1. Complete the form for each condenser used as a control device within the PVC production facility, or for any condenser that emits directly to atmosphere.

2. Refer to "Enclosure 1" for additional instructions and details.

1 Type of Equipment or Device

2 Equipment of Device ID

3 Type of Condenser

4 If other, provide a description:

5 Is the condenser refrigerated?

6 Describe the materials condensed:

7 Describe the fate of the non-condensed gas stream:

8 Describe the fate of the condensate outlet stream:

9 Gas inlet flow rate (dscfm):

10 Gas inlet temperature (°F):

11 Gas outlet temperature (°F):

12 Liquid outlet for rate (gpm):

15 Year Equipment Installed:

16 Equipment Currently Regulated Under (cite regulations):

Page 1 of 1

DRAFT PVC Section 114 Survey Part 1

06/23/2009
FORM H

EQUIPMENT LEAKS

Instructions

1. Submit a copy of the leak detection and repair procedures for the PVC production facility and provide responses to the questions below.

2. Refer to "Enclosure 1" for additional instructions and details.

Table 1. LDAR Program

Table 2. Equipment Counts

In Source 

Category

Subtotal of Equipment Associated 

with Closed Vent System(s)

(Subset of count in source category)

In heavy liquid service

In gas, vapor, and light liquid service

Connectors

In heavy liquid service

In gas, vapor, and light liquid service

Agitators

In liquid service

In gas and vapor service

Pressure Relief Devices

Open ended valves and lines

Sampling connection systems

Compressors

Instrumentation systems

Valves

In heavy liquid service

In light liquid service

Pumps

40 CFR Part 61, Subpart V

Other Federal LDAR Regulation

Specify: 

State LDAR Regulation

Specify:

Provide the total cost to your facility for conducting the LDAR 

program at this process unit in 2013:

Equipment

In heavy liquid service

In gas, vapor, and light liquid service

Is there an equipment leak detection and repair (LDAR) 

program for all equipment at your facility included in the 

source category?

If "No," how are equipment leaks detected and repaired?

If "Yes," is the equipment subject to the requirements of:

40 CFR Part 63, Subpart UU

Page 1 of 1

DRAFT PVC Section 114 Survey Part 1

06/23/2009
FORM K-1

TANKS, VESSELS AND PORTABLE CONTAINERS USED FOR FEEDSTOCK STORAGE, PRODUCT STORAGE, VENT GAS STORAGE, HOLDING AND WASTEWATER

Instructions

1. Complete this form for 2013 only.

2. Provide copies of estimation worksheets and any other relevant documentation.

3. Complete this form for individual equipment, including equipment that is not assigned an equipment ID (e.g., portable containers).

4. Do not include gas holders on this form. 

5. Refer to "Enclosure 1" for additional instructions and details.

Table 1.

Table 2.

Vapor Pressure Total Emissions

(in H2O) Minimum Maximum Average (pounds)

(select HAP)

(select HAP)

(select HAP)

(select HAP)

(select HAP)

(select HAP)

(select HAP)

(select HAP)

(select HAP)

(select HAP)

(select HAP)

If Other, please specify, being as descriptive as possible:

Source Process Equipment ID (if applicable):

Equipment Description:

If not provided in the equipment description above, 

describe the tank, vessel, or container and indicate (if 

applicable) if the tank is a fixed, floating internal, or floating 

external roof. 

Select the purpose of the equipment:

If Yes, How Are The Emissions Controlled?

Concentration (ppmvd @ 3% O2)

How is the HAP Concentration Determined?

Are HAP Emissions Controlled?

Individual HAP Present

Source Equipment Type:

Number of turnovers:

Equipment volume (m3):

Notes

Storage Temperature (°F)

Page 1 of 1

DRAFT PVC Section 114 Survey Part 2

06/23/2009
FORM L

STARTUP, SHUTDOWN, AND MALFUNCTION

Instructions

1. Complete this form for 2013 only.

2. Submit with your response to this survey, copies of all records of emissions during periods of process startup, shutdown, and malfunctions for 2013 only.

3. Refer to "Enclosure 1" for additional instructions and details.

For a malfunction:

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

(select HAP) (pounds)

Total Emissions During Startup, Shutdown, 

or Malfunction Event

Were all of the emissions control devices 

operating for the entire duration of the startup, 

shutdown, or malfunction event?

Startup, Shutdown or Malfunction?

If startup or shutdown, what was the 

duration (hours):

Provide a short description of 

the malfunction and the 

circumstances:

If No, which control devices were not operating 

(Control Equipment ID), for how long, and why:

Were permitted emissions limits exceeded?

Provide a description of the 

procedures used to alert the 

owner/operator that the 

malfunction occurred. If the malfunction resulted in 

a release of emissions, 

describe any indicators used 

to signal and/or measure the 

release.

Is there a written startup, shutdown and/or 

malfunction plan for the process unit?

Provide a description of the systems and 

equipment in place that function to notify 

operators that a malfunction is occurring .

Applicable standard or regulation:

Describe what actions, if any, were taken to 

minimize emissions to the atmosphere:

Page 1 of 1

DRAFT PVC Section 114 Survey Part 1

06/23/2009
FORM P

PROCESS VENT EMISSIONS TESTING DATA

Instructions

1. Copy this worksheet as necessary for pollutants/compounds sampled on different dates.

2. For multiple control devices, users may copy this worksheet within this workbook.

Control Equipment ID:

Indicate whether the inlet to the control device is from the PVC process only ("dedicated") or from the PVC 

process and another process unit (non-PVC) ("combined"):

Parameter

Test Date (mm/dd/yy)

Required Operating Parameters During Test

Total Heat Input (MMBtu/hr)

Fuel 1

Feed Rate

HHV

Fuel 2

Feed Rate

HHV

Fuel 3

Feed Rate

HHV

Flow Rate

Temperature

Moisture

O2

CO2

Number of PVC resin grades being produced during sampling

Number of PVC resin grades being produced (as percentage of all resin grades produced by facility)

Testing Data

Compound

Benzene

Chloroethane

Chloroform

Chloroprene

1,1-Dichloroethane

1,2-Dichloroethane

n-Hexane

Methylene chloride

Toluene

1,1,1-Trichloroethane

1,1,2-Trichloroethane
Vinylidene chloride

Acetophenone

Bis(2-ethylhexyl) phthalate (DEHP)

1,4-Dichlorobenzene

2,4-Dinitrophenol

Hexachlorobutadiene

Hydroquinone

Naphthalene

Phenol

1,2,4-Trichlorobenzene

Acetaldehyde

1,3-Butadiene

Chlorobenzene

Chloromethane

Cumene

Ethylbenzene

Ethylene glycol

Formaldehyde

Methanol

1,1,2,2-Tetrachloroethane

2,2,4-Trimethylpentane

Vinyl acetate

Vinyl bromide

Xylenes (isomers and mixtures)

Vinyl chloride

Total hydrocarbon (THC)

Methane (CH4)
CAS Number Run #1 Run #2 Run #3 Units

Enter the CAS number for 

each pollutant/compound. 

Do not include dashes.

Select appropriate unit from list.

MMBTU/hr

MMBTU/hr

BTU/scf

MMBTU/hr

BTU/scf

MMBTU/hr

BTU/scf

dscfm

deg F

%

%

%

%

CAS Number

71432 ppmvd @ 3% O2

75003 ppmvd @ 3% O2

67663 ppmvd @ 3% O2

126998 ppmvd @ 3% O2

75343 ppmvd @ 3% O2

107062 ppmvd @ 3% O2

110543 ppmvd @ 3% O2

75092 ppmvd @ 3% O2

108883 ppmvd @ 3% O2

71556 ppmvd @ 3% O2

79005 ppmvd @ 3% O2

Enter numerical value only.

Enter numerical value only.
75354 ppmvd @ 3% O2

98862 ppmvd @ 3% O2

117817 ppmvd @ 3% O2

106467 ppmvd @ 3% O2

51285 ppmvd @ 3% O2

87683 ppmvd @ 3% O2

123319 ppmvd @ 3% O2

91203 ppmvd @ 3% O2

108952 ppmvd @ 3% O2

120821 ppmvd @ 3% O2

75070 ppmvd @ 3% O2

106990 ppmvd @ 3% O2

108907 ppmvd @ 3% O2

74873 ppmvd @ 3% O2

98828 ppmvd @ 3% O2

100414 ppmvd @ 3% O2

107211 ppmvd @ 3% O2

50000 ppmvd @ 3% O2

67561 ppmvd @ 3% O2

79345 ppmvd @ 3% O2

540841 ppmvd @ 3% O2

108054 ppmvd @ 3% O2

593602 ppmvd @ 3% O2

1330207 ppmvd @ 3% O2

75014 ppbvd @ 3% O2

N/A ppmvd as propane @ 3% O2

74828 ppmvd @ 3% O2
Run # 1 Detection Run # 2 Detection Run # 3 Detection

Identify the status of measured 

values relative to the detection 

levels

Identify the status of measured 

values relative to the detection 

levels

Identify the status of measured 

values relative to the detection 

levels

Analysis Method Used Note(s)

Where applicable, select the analysis method 

used.

For all pollutants/compounds, provide any other information 

supporting information you think is necessary about this test 

report. 

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B
SW-846 Method 8260B

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

US EPA Method 18

US EPA Method 25A
FORM Q

TOTAL HYDROCARBON 30-DAY MONITORING

Instructions

1. For multiple control devices, users may copy this worksheet within this workbook.

2. Add additional rows as necessary to provide 30 days of monitoring data.

Control Equipment ID:

Date and Time THC Reading CH4 Reading O2 level in exhaust gas

MM/DD/YYYY HH:MM (ppmvd as propane @ 3% O2) (ppmvd @ 3% O2) (% by volume, dry)

Indicate whether the inlet to the control device is from the PVC process only ("dedicated") or from the 

PVC process and another process unit (non-PVC) ("combined"):














Moisture in exhaust 

gas

PVC Type PVC Grade Control Device 

Temperature

(% by volume) (e.g., suspension, 

dispersion/emulsion, bulk, etc.) (e.g., GP, HMW, LMW, etc.) (degF)














Control Device 

Operations Indicator

THC Monitoring 

Operations Indicator 

(note periods of start-up, 

Shutdown, malfunctions, or 

normal operation) 

(note periods of abnormal 

operations)