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AIR QUALITY

520 LAFAYETTE ROAD

ST. PAUL, MN 55155-4194

PERMIT APPLICATION FORM GI-05A

POLLUTION CONTROL

EQUIPMENT INFORMATION

07/25/05

1) AQ Facility ID No.: 2) Facility Name:

3a) 3b) 3c) 3d) 3e) 3f) 3g) 3h) 3i)

Control 

Equip 

ID No.

CE 

Type 

Code

Description Manufacturer Model No. Pollutants 

Controlled

Capture 

Efficiency

Destruct/

Collect 

Efficiency

Afterburner 

Combustion 

Parameters
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INSTRUCTIONS FOR FILLING OUT AQ FORM

GI-05A Pollution Control Equipment Information

1) AQ Facility ID No. -- Fill in your Air Quality Facility ID Number as indicated on the 

Facility Information Form (GI-01), item 1a.

2) Facility Name -- Enter your facility name as indicated on the Facility Information Form

(GI-01), item 2.

3a) Control Equipment (CE) ID No. -- Assign a Control Equipment ID number to each 

piece of pollution control equipment (e.g., fabric filter or afterburner) or pollution control 

practice (e.g., dust suppression by water spray). Number the pollution control 

equipment/practices at your facility sequentially (001, 002, 003, etc.). The assigned 

number will be used in other forms to identify control equipment that is described in this 

form. This ID number is unique to this piece of equipment and must be used consistently 

throughout the application.

If you are adding new pollution control equipment to your permit or replacing existing 

pollution control equipment, it is important not to reuse previously used CE numbers. 

The new or replacement control equipment should be numbered consecutively beginning 

with the next number after the last one used. Numbers used for removed control 

equipment cannot be reused for new or replacement control equipment.

3b) CE Type Code -- Fill in the appropriate Control Equipment (CE) Type Code from Table 

GI-05A.1 at the end of these instructions. For control equipment or pollution control 

practices that are not listed in Table GI-05A.1, enter the CE Type Code 099 for "other" 

and describe the equipment or practice. The type-code for the control equipment must 

be entered correctly, since this will be the primary means of recording and 

identifying the type of air pollution control equipment at this facility. 

3c) Description -- Fill in the appropriate control equipment or control practice description. 

This description must correspond with the Control Equipment Type Code in the second 

column (Item 3b). For control equipment assigned Control Equipment Type Code 099, 

please provide a detailed description of the control equipment or pollution control 

practice; use additional pages if necessary. 

3d) Manufacturer -- Fill in the name of the pollution control equipment manufacturer. 

Pollution control practices such as dust suppression by water spray or chemical oxidation 

may not use control equipment. In these cases, fill N/A for items 3d and 3e.

3e) Model No. -- Fill in the manufacturer's model number for the pollution control 

equipment. If no control equipment is used, fill in NA.

3f) Pollutants Controlled -- Fill in the pollutants controlled. If multiple pollutants are 

controlled, enter the criteria pollutants first in alphabetical order, followed by

Hazardous Air Pollutants in alphabetical order. The pollutants identified in this 

column should match one or more of the pollutants listed in Table GI-05A.1. Pollutants 

other than those listed in Table GI-05A.1 (such as Hazardous Air Pollutants) that are 

controlled by the control equipment or pollution control practice should also be listed in 

this column. List each pollutant in a column filling in each box with only one pollutant. 
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For example, if a wet scrubber is used to control both acid gas and particulate matter 

emissions from an emissions unit at your facility, list PM in the first row, and SOx, and 

PM10 in the second and third rows. It is not necessary to repeat the other information in 

the other columns (i.e., equipment manufacturer's name, equipment model number, etc.).

3g) Capture Efficiency -- Fill in the capture efficiency of the emission capture device. The 

capture efficiency is the portion of the pollutants emitted that are routed via ducting to the 

control equipment (e.g., a fabric filter). For emission units in which all of the pollutants 

emitted are routed via ducting to a fabric filter the capture efficiency is 100 %. These 

devices are called total enclosures. Total enclosure is defined in Minnesota Rules as “an 

enclosure that completely surrounds emissions from an emissions unit such that all 

emissions are captured and discharged through ductwork to control equipment”.

Hoods and other devices that do not completely surround the emissions from an emission 

unit do not capture all of the pollutants emitted and therefore have a capture efficiency 

that is less than 100 %. An example of a hood is a three-sided spray booth because the 

enclosure does not completely surround the emissions.

If you are applying for an operating permit, if the capture efficiency has been determined 

by performance testing in accordance with Minn. R. 7017.2001 to 7017.2060, and the test 

report has been reviewed and approved by the Agency, the determined efficiency must be 

used.

If you are applying for an operating permit and the capture efficiency has not been 

determined by a performance test, but the capture device is a hood that has been evaluated 

and conforms with the requirements of "Industrial Ventilation- A Manual of 

Recommended Practices", 21st ed., fill in 80 % for particulate matter or 60% for volatile 

organic compounds. Hood evaluations must be conducted by qualified personnel and a 

responsible official must sign the certification below. If the capture device is a total 

enclosure, fill in 100 %. The certification must be submitted with the application.

Hoods that have not been evaluated or do not conform to the recommended design and 

operating practices in "Industrial Ventilation- A Manual of Recommended Practices", 

21st ed., must be either evaluated and brought into conformity with those design and 

operating practices or tested in accordance with Minn. R. 7017.2001 to 7017.2060, and 

the test report reviewed and approved and approved by the Agency, to determine a 

capture efficiency. You may propose an alternative capture efficiency based on 

engineering calculations approved by the Commissioner.

If you are applying for a modification to an existing emission unit with a hood to collect 

emissions, for the purpose of determining if the proposed change is a Title I modification, 

you may not assume a capture efficiency for the hood unless the use of the hood is part of 

an enforceable permit (For the definition of Title I modification, refer to Minn. R. 

7007.0100, subp. 26.). You may assume a capture efficiency of 80 % (for particulate 

matter) or 60% (for volatile organic compounds) for a hood included in an enforceable 

permit if the hood has been evaluated and conforms with the design and operating 

practices recommended in "Industrial Ventilation- A Manual of Recommended Practices, 

21st ed., American Conference of Governmental Industrial Hygienists". A responsible 

official shall sign the following hood certification to be submitted with the application:
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HOOD CERTIFICATION

I certify under penalty of law that the aforementioned hood(s) has (have) been 

evaluated under my direction or supervision by qualified personnel and that, to the 

best of my knowledge and belief, the (each) hood conforms to the design and 

operating practices recommended in "Industrial Ventilation- A Manual of 

Recommended Practices, 21st ed., American Conference of Governmental Industrial 

Hygienists."

The results of the evaluation and a copy of the certification must be kept on site. The 

owner or operator must make this evaluation and certification available for examination 

and copying upon request of the Commissioner and must, upon request, submit these 

records to the Commissioner by the time specified in the request.

3h) Destruct/Collect Efficiency -- Fill in the collection or destruction efficiency. The 

collection or destruction efficiency is the portion of the pollutants that are captured and 

routed to the control equipment that is either collected and retained in the control 

equipment or is destroyed by the control equipment. Environmental Protection Agency 

publications and data bases are the preferred sources for destruction/collection efficiency 

factors. Other sources include Minnesota Pollution Control Agency control efficiency 

factors and manufacturer's guarantees.

The following table lists most of the types of air pollution control equipment in use. For 

each type for the pollutants commonly controlled by that type, an efficiency is given. 

This is one source you may use for destruction/collection efficiency. For any 

destruction/collection efficiency you enter here, for either a criteria pollutant or a HAP, 

you must indicate in a compliance plan on Form CD-01 how you will demonstrate and

maintain the efficiency. Attach additional sheets as needed to explain the basis for the 

proposed efficiency, if the efficiency is not from the following table (Table GI-05A.1). 

Since there are no efficiencies in Table GI-05A.1 for HAPs, you must always attach a 

description of the basis for any efficiency for HAPs which you enter.

The efficiency you enter here is the efficiency of control you may assume for the purpose 

of calculating Controlled Emissions and Actual Emissions as required on the EC forms. 

Note that the efficiency on the EC Forms, pollution control efficiency, is the product of 

the capture efficiency and the destruction/collection efficiency. You must propose a 

compliance plan on Form CD-01 for each control device for which you assume an 

efficiency to comply with an applicable requirement, such an emission limit, or to avoid 

an applicable requirement, such as a synthetic minor limit to obtain a State permit or to be 

exempt from New Source Review. Form GI-09C helps you decide whether to propose a 

synthetic minor limit to avoid New Source Review. If your compliance plan is 

acceptable, the control efficiency becomes enforceable when your permit is issued.

Minn. R. 7011.0070 contains a shorter list of control equipment and efficiencies for 

criteria pollutants which are enforceable and may be used in calculating your Potential-toEmit to determine what type of permit to apply for, provided you comply with the 

compliance demonstration requirements in that Rule. If you use the control efficiencies 

in Minn. R. 7011.0070, you must include the compliance demonstration requirements in 

that Rule in your Compliance Plan on Form CD-01. Note that you cannot use the control 
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efficiencies in Minn. R. 7011.0070 to calculate Potential-to-Emit to determine if you 

require a permit.

If you conducted a performance test which demonstrates a higher efficiency than Table 

GI-05A.1, and which was reviewed and accepted by the Agency, you may propose that 

efficiency. If you conducted a test which demonstrates a lower efficiency than Table GI05A.1, you must use the lower efficiency to complete this and all other forms.

3i) Afterburner Combustion Parameters -- Fill in the combustion parameters for 

afterburners only. The parameters of interest are the temperature and residence time of 

the unit. Please state the temperature in degrees Fahrenheit and the residence time in 

seconds. List the parameters in a column, filling in each square with only one parameter 

(i.e., minimum operating temperature and residence time). For example, list the unit's 

minimum operating temperature in the first row and the residence time in the second row. 

It is not necessary to repeat the other information in the other columns (i.e., equipment 

manufacturer's name, equipment model number, etc.). Recommended monitoring, 

recordkeeping, operation and maintenance guidelines for other types of control equipment 

are included in Tables CD-01.2 and CD-01.3 following in the instructions for completing 

Form CD-01.

TABLE GI-05A.1

CE Control Device, Pollution Control Efficiency (%)

Code Pollution Control Practice PM PM10 SOx NOx VOC CO Pb

001 Wet scrubber, high eff. 90 90 30 - - - - - - - - - 72

002 Wet scrubber, med. eff. 25 25 - - - - - - - - - - - - 20

003 Wet scrubber, low eff. 20 20 - - - - - - - - - - - - 16

004 Gravity collector, high eff. 4 4 - - - - - - - - - - - - 3

005 Gravity collector, med. eff. 3 3 - - - - - - - - - - - - 2

006 Gravity collector, low eff. 2 2 - - - - - - - - - - - - 1

007 Centrifugal collector (cyclone), high eff. 80 80 - - - - - - - - - - - - 64

008 Centrifugal collector (cyclone), med. eff. 50 50 - - - - - - - - - - - - 40

009 Centrifugal collector (cyclone), low eff. 10 10 - - - - - - - - - - - - 8

010 Electrostatic precipitator (boilers), high eff. 95 95 - - - - - - - - - - - - 76

010 Electrostatic precipitator (other), high eff. 95 95 - - - - - - - - - - - - 76

011 Electrostatic precipitator (boilers), med. eff. 50 50 - - - - - - - - - - - - 40

011 Electrostatic precipitator (other), med. eff. 80 80 - - - - - - - - - - - - 64

012 Electrostatic precipitator (boilers), low eff. 40 40 - - - - - - - - - - - - 32

012 Electrostatic precipitator (other), low eff. 70 70 - - - - - - - - - - - - 56

013 Gas scrubber (general) - - - - - - 30 - - - - - - - - - - - -

014 Mist eliminator (v>250 ft/min), high vel. 10 10 - - - - - - - - - - - - 8

015 Mist eliminator (v<250 ft/min), low vel. 5 5 - - - - - - - - - - - - 4

016 Fabric filter (T>250 °F), high temp. 99 99 - - - - - - - - - - - - 79

017 Fabric filter (180 °F >T>250 °F), med. Temp. 99 99 - - - - - - - - - - - - 79

018 Fabric filter (T<180 °F), low temp. 99 99 - - - - - - - - - - - - 79

019 Catalytic afterburner, no heat exch. - - - - - - - - - - - - 95 90 - - -

020 Catalytic afterburner, w/heat exch. - - - - - - - - - - - - 95 90 - - -

021 Direct flame afterburner, no heat exch. - - - - - - - - - - - - 95 99 - - -

022 Direct flame afterburner, w/heat exch. - - - - - - - - - - - - 95 99 - - -
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CE Control Device, Pollution Control Efficiency (%)

Code Pollution Control Practice PM PM10 SOx NOx VOC CO Pb

023 Flaring - - - - - - - - - - - - 98 95 - - -

024 Modified furnace or burner design - - - - - - - - - 20 - - - - - - - - -

025 Staged combustion - - - - - - - - - 20 - - - - - - - - -

026 Flue gas recirculation - - - - - - - - - 20 - - - - - - - - -

027 Reduced combustion - air preheat - - - - - - - - - 20 - - - - - - - - -

028 Steam or water injection - - - - - - - - - 20 - - - - - - - - -

029 Low excess - air firing - - - - - - - - - 10 - - - - - - - - -

030 Fuel w/low nitrogen content - - - - - - - - - 10 - - - - - - - - -

031 Air injection - - - - - - - - - - - - - - - - - - - - -

032 Ammonia injection - - - - - - - - - - - - - - - - - - - - -

033 Control of % O2 in combustion Air - - - - - - - - - - - - - - - - - - - - -

034 Wellman-Lord/sodium sulfite scrubbing - - - - - - 50 - - - - - - - - - - - -

035 Magnesium oxide scrubbing - - - - - - 50 - - - - - - - - - - - -

036 Dual alkali scrubbing - - - - - - 50 - - - - - - - - - - - -

037 Citrate process scrubbing - - - - - - 50 - - - - - - - - - - - -

038 Ammonia scrubbing - - - - - - 50 - - - - - - - - - - - -

039 Cat. Oxidation - flue gas desulfurization - - - - - - 75 - - - - - - - - - - - -

040 Alkalized alumina - - - - - - 75 - - - - - - - - - - - -

041 Dry limestone injection - - - - - - 40 - - - - - - - - - - - -

042 Wet limestone injection - - - - - - 80 - - - - - - - - - - - -

043 Sulfuric acid plant- contact process - - - - - - 50 - - - - - - - - - - - -

044 Sulfuric acid plant- double contact process - - - - - - 95 - - - - - - - - - - - -

045 Sulfur plant - - - - - - 85 - - - - - - - - - - - -

047 Vapor recovery system (Including condensers, 

hoods, other encl.)

- - - - - - - - - - - - 85 - - - - - -

048 Activated carbon adsorption - - - - - - - - - - - - 85 - - - - - -

049 Liquid filtration system 50 50 - - - - - - - - - - - - 40

050 Packed-gas absorption column 90 90 70 - - - 70 - - - 72

051 Tray-type gas absorption column 25 25 70 - - - 70 - - - 20

052 Spray tower 20 20 70 - - - 70 - - - 16

053 Venturi scrubber 90 90 30 - - - 70 - - - 72

055 Impingement plate scrubber 25 25 - - - - - - - - - - - - 20

056 Dynamic separator (dry) 90 90 - - - - - - - - - - - - 72

057 Dynamic separator (wet) 50 50 - - - - - - - - - - - - 40

058 Mat or panel filter 92 92 - - - - - - - - - - - - 74

059 Metal fabric filter screen (cotton gins) 10 10 - - - - - - - - - - - - 8

060 Process gas recovery - - - - - - - - - - - - 95 99 - - -

061 Dust suppression by water spray, 10,000 gal/min 40 40 - - - - - - - - - - - - 32

062 Dust suppression by chemical stabilizers or wetting 

agents, 350 gal/min

40 40 - - - - - - - - - - - - 32

063 Gravel bed filter - - - - - - - - - - - - - - - - - - - - -

064 Annular ring filter 80 80 - - - - - - - - - - - - 64

065 Catalytic reduction - - - - - - - - - 75 - - - - - - - - -

066 Molecular sieve - - - - - - - - - 95 - - - - - - - - -

067 Wet lime slurry scrubbing - - - - - - 50 - - - - - - - - - - - -

068 Alkaline fly ash scrubbing - - - - - - 50 - - - - - - - - - - - -

069 Sodium carbonate scrubbing - - - - - - 50 - - - - - - - - - - - -

070 Sodium-alkali scrubbing - - - - - - 50 - - - - - - - - - - - -

071 Fluid bed dry scrubber 10 10 - - - - - - - - - - - - 8

072 Tube and shell condenser - - - - - - - - - - - - - - - - - - - - -
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CE Control Device, Pollution Control Efficiency (%)

Code Pollution Control Practice PM PM10 SOx NOx VOC CO Pb

073 Refrigerated condenser - - - - - - - - - - - - - - - - - - - - -

074 Barometric condenser - - - - - - - - - - - - - - - - - - - - -

075 Single cyclone 10 10 - - - - - - - - - - - - 8

076 Multiple cyclone w/o fly ash reinjection 80 80 - - - - - - - - - - - - 64

077 Multiple cyclone w/ fly ash reinjection 50 50 - - - - - - - - - - - - 40

080 Chemical oxidation - - - - - - - - - - - - - - - - - - - - -

081 Chemical reduction - - - - - - - - - - - - - - - - - - - - -

082 Ozonation - - - - - - - - - - - - - - - - - - - - -

083 Chemical neutralization - - - - - - - - - - - - - - - - - - - - -

084 Activated clay adsorption - - - - - - - - - - - - - - - - - - - - -

085 Wet cyclone separator 50 50 - - - - - - - - - - - - 40

086 Water curtain 10 10 - - - - - - - - - - - - 8

099 Other control equipment or pollution control 

practices

- - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - - - -

101 High efficiency particulate air filter (HEPA) - - - - - - - - - - - - - - - - - - - - -

106 Dust suppression by physical stabilization - - - - - - - - - - - - - - - - - - - - -

107 Selective noncatalytic reduction for NOX - - - - - - - - - - - - - - - - - - - - -

109 Catalytic oxydizer - - - - - - - - - - - - - - - - - - - - -

113 Rotoclone - - - - - - - - - - - - - - - - - - - - -

131 Thermal oxydizer - - - - - - - - - - - - - - - - - - - - -

139 Selective catalytic reduction (SCR) - - - - - - - - - - - - - - - - - - - - -

146 Wet electrostatic precipitator - - - - - - - - - - - - - - - - - - - - -

159 Electrified filter bed - - - - - - - - - - - - - - - - - - - - -

203 Catalytic converter - - - - - - - - - - - - - - - - - - - - -

204 Overfire air - - - - - - - - - - - - - - - - - - - - -

205 Low NOX burners - - - - - - - - - - - - - - - - - - - - -

206 Dry sorbent injection - - - - - - - - - - - - - - - - - - - - -

207 Carbon injection - - - - - - - - - - - - - - - - - - - - -

901 Moisture content of material, 2-3% 90 90 - - - - - - - - - - - - - - -

902 Moisture content of material, 4% 95 95 - - - - - - - - - - - - - - -

903 Moisture content of material, 5% - - - - - - - - - - - - - - - - - - - - -

904 Moisture content of material, 6% or more 99 99 - - - - - - - - - - - - - - -

905 Paper filter (not accordion) - - - - - - - - - - - - - - - - - - - - -

906 Fiberglass filter (with cardboard frame) - - - - - - - - - - - - - - - - - - - - -

907 Fiberglass filter (without cardboard frame) - - - - - - - - - - - - - - - - - - - - -

908 Andre -- cardboard Binks filter (accordion) - - - - - - - - - - - - - - - - - - - - -

909 Roll media -- fiberglass tack filter (tacky on one 

side)

- - - - - - - - - - - - - - - - - - - - -

910 Split paper + polyester paint arrestor - - - - - - - - - - - - - - - - - - - - -