OMB Control No. 2060-0003 

Approval expires 04/30/2012 

EPA Form No. 5900-247 

United States Environmental Protection Agency

Program

Address

Phone

Fax

Web address

Reviewing Authority 

Program 

Address 

Phone 

Fax 

Web address

FEDERAL MINOR NEW SOURCE REVIEW PROGRAM IN INDIAN COUNTRY 

Registration for Existing Sources 

(FORM REG) 

Please submit information to: 

[Reviewing Authority 

Address 

Phone] 

A. GENERAL SOURCE INFORMATION 

1. Company Name 2. Source Name 

3. Type of Operation 4. Portable Source?  Yes  No 

5. Temporary Source?  Yes  No 

6. NAICS Code 7. SIC Code 

8. Physical Address (home base for portable sources)

9. Reservation* 10. County* 11a. Latitude* 11b. Longitude* 

12a. Quarter-Quarter Section* 12b. Section* 12c. Township* 12d. Range* 

* Provide all locations of operation for portable sources 
OMB Control No. 2060-0003 

Approval expires 04/30/2012 

EPA Form No. 5900-247 

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B. CONTACT INFORMATION 

1. Owner Name Title 

Mailing Address

Email Address 

Telephone Number Facsimile Number

2. Operator Name (if different from owner) Title 

Mailing Address

Email Address 

Telephone Number Facsimile Number

3. Source Contact Title 

Mailing Address

Email Address 

Telephone Number Facsimile Number

4. Compliance Contact Title 

Mailing Address

Email Address 

Telephone Number Facsimile Number
OMB Control No. 2060-0003 

Approval expires 04/30/2012 

EPA Form No. 5900-247 

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C. ATTACHMENTS 

Include all of the following information as attachments to this form 

 Narrative description of the operations 

 Identification and description of all emission units and air pollution generating activities (with the exception of 

the exempt emissions units and activities listed in §49.153(c) 

 Identification and description of any existing air pollution control equipment and compliance monitoring 

devices or activities 

 Type and amount of each fuel used 

 Type raw materials used 

 Production Rates 

 Operating Schedules 

 Any existing limitations on source operations affecting emissions or any work practice standards, where 

applicable, for all regulated NSR pollutants at your source. 

 Total allowable (potential to emit if there are no legally and practically enforceable restrictions) emissions from 

the air pollution source for the following air pollutants: particulate matter, PM10, PM2.5, sulfur oxides (SOx), 

nitrogen oxides (NOx), carbon monoxide (CO), volatile organic compound (VOC), lead (Pb) and lead compounds, 

fluorides (gaseous and particulate), sulfuric acid mist (H2SO4), hydrogen sulfide (H2S), total reduced sulfur (TRS) 

and reduced sulfur compounds, including all calculations for the estimates. 

 Estimates of the total actual emissions from the air pollution source for the following air pollutants: particulate 

matter, PM10, PM2.5, sulfur oxides (SOx), nitrogen oxides (NOx), carbon monoxide (CO), volatile organic 

compound (VOC), lead (Pb) and lead compounds, ammonia (NH3), fluorides (gaseous and particulate), sulfuric 

acid mist (H2SO4), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds, including 

all calculations for the estimates. 

 Other 

[Disclaimers] The public reporting and recordkeeping burden for this collection of information is estimated 

to average 6 hours per response. Send comments on the Agency’s need for this information, the accuracy of 

the provided burden estimates, and any suggested methods for minimizing respondent burden, including 

through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. 

Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include 

the OMB control number in any correspondence. Do not send the completed form to this address. 
OMB Control No. 2060-0003 

Approval expires 04/30/2012 

EPA Form No. 5900-247 

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D. TABLE OF ESTIMATED EMISSIONS 

The following estimates of the total emissions in tons/year for all pollutants contained in your worksheet 

stated above should be provided. 

Pollutant Total Actual 

Emissions (tpy) 

Total Allowable or 

Potential Emissions 

(TPY) 

PM 

PM10 

PM 2.5 

SOx 

NOx 

CO 

VOC 

Pb 

NH3 

Fluorides 

H2SO4

H2S 

TRS 

RSC 

Emissions calculations must include fugitive emissions if the source is one the following listed 

sources, pursuant to CAA Section 302(j): 

(a) Coal cleaning plants (with thermal dryers); 

(b) Kraft pulp mills; 

(c) Portland cement plants; 

(d) Primary zinc smelters; 

(e) Iron and steel mills; 

(f) Primary aluminum ore reduction plants; 

(g) Primary copper smelters; 

(h) Municipal incinerators capable of charging more than 

250 tons of refuse per day; 

(i) Hydrofluoric, sulfuric, or nitric acid plants; 

(j) Petroleum refineries; 

(k) Lime plants; 

(l) Phosphate rock processing plants; 

(m) Coke oven batteries; 

(n) Sulfur recovery plants; 

(o) Carbon black plants (furnace process); 

(p) Primary lead smelters; 

(q) Fuel conversion plants; 

(r) Sintering plants; 

(s) Secondary metal production plants; 

(t) Chemical process plants 

(u) Fossil-fuel boilers (or combination thereof) totaling 

more than 250 million British thermal units per hour 

heat input; 

(v) Petroleum storage and transfer units with a total 

storage capacity exceeding 300,000 barrels; 

(w) Taconite ore processing plants; 

(x) Glass fiber processing plants; 

(y) Charcoal production plants; 

(z) Fossil fuel-fired steam electric plants of more that 

250 million British thermal units per hour heat input, 

and 

(aa) Any other stationary source category which, as of 

August 7, 1980, is being regulated under section 111 

or 112 of the Act. 
OMB Control No. 2060-0003 

Approval expires 04/30/2012 

EPA Form No. 5900-247 

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Instructions 

Please answer all questions. If the item does not apply to the source and its operations write “n/a”. If 

the answer is not known write "unknown". 

A. General Source Information 

1. Company Name: Provide the complete company name. For corporations, include divisions or subsidiary 

name, if any. 

2. Source Name: Provide the source name. Please note that a source is a site, place, location, etc... that may 

contain one or more air pollution emitting units. 

3. Type of Operation: Indicate the generally accepted name for the operation (i.e., asphalt plant, gas station, dry 

cleaner, sand & gravel mining, oil and gas well site, tank battery, etc.). 

4. Portable Source: Does the source operate in more than one location? Some examples of portable sources 

include asphalt batch plants and concrete batch plants. 

5. Temporary Source: A temporary source, in general, would have emissions that are expected last less than 2 

years. Do you expect to cease operations within the next 2 years? 

 

6. NAICS Code: North American Industry Classification System. The NAICS Code for your source can be 

found at the following link  North American Industry Classification System

(http://www.census.gov/epcd/naics/nsic2ndx.htm#S1). 

7. SIC Code: Standard Industrial Classification Code. Although the new North American Industry 

Classification System (NAICS) has replaced the SIC codes, much of the Clean Air Act permitting processes 

continue to use these codes. The SIC Code for your source can be found at the following link  Standard 

Industrial Classification Code (http://www.osha.gov/pls/imis/sic_manual.html). 

8. Physical Address: Provide the actual address of where the source is operating, not the mailing address. 

Include the State and the ZIP Code. 

9. Reservation: Provide the name of the Indian reservation within which the source is operating. 

10. County: Provide the County within which the source is operating. 

11a & 11b. Latitude & Longitude: These are GPS (global positioning system) coordinates. This information 

can be provided in decimal format or degree-minute-second format. 

12a – 12d. Section-Township-Range: Please provide these coordinates in Quarter-Quarter 

Section/Section/Township/Range. (e.g., SW 1⁄4, NE 1⁄4 /S36/T10N/R21E). 
OMB Control No. 2060-0003 

Approval expires 04/30/2012 

EPA Form No. 5900-247 

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B. Contact Information 

Please provide the information requested in full.

1. Owners: List the full name (last, middle initial, first) of all owners of the source. 

2. Operator: Provide the name of the operator of the source if it is different from the owner(s). 

3. Source Contact: The source contact must be the local contact authorized to receive requests for data and 

information. 

4. Compliance Contact: The compliance contact must be the local contact responsible for the source’s 

compliance with this rule. If this is the same as the Source Contact please note this on the form. 

C. Attachments 

The information requested in the attachments will enable EPA to understand the type of 

source being registered and the nature and extent of the air pollutants being emitted. 

D. Total Emissions 

1. Allowable Emissions (See also, Potential to Emit): Emissions rate of a source calculated 

using the maximum rated capacity of the source (unless the source is subject to practically 

and legally enforceable limits which restrict the operating rate, or hours of operation, or 

both) and the most stringent of the following: 

a) Any applicable standards as set forth in 40 CFR parts 60 and 61; 

b) Any applicable Tribal or Federal Implementation Plan emissions limitation, including 

those with a future compliance date; or 

c) Any emissions rate specified as a federally enforceable permit condition, including 

those with a future compliance date. 

2. Potential to Emit: The maximum capacity of a source to emit a pollutant under its physical 

and operational design. Any physical or operational limitation on the capacity of the 

source to emit a pollutant, including air pollution control equipment and restrictions on 

hours of operation or on the type or amount of material combusted, stored, or processed, 

shall be treated as part of its design if the limitation or the effect it would have on 

emissions is enforceable as a practical matter. See Allowable Emissions. 

Actual Emissions: Estimates of actual emissions must take into account equipment, operating 

conditions, and air pollution control measures. For a source that operated during the entire calendar 

year preceding the initial registration submittal, the reported actual emissions typically should be the 

annual emissions for the preceding calendar year, calculated using the actual operating hours, 

production rates, in-place control equipment, and types of materials processed, stored, or combusted 

during the preceding calendar year. However, if you believe that the actual emissions in the preceding 

calendar year are not representative of the emissions that your source will actually emit in coming 
OMB Control No. 2060-0003 

Approval expires 04/30/2012 

EPA Form No. 5900-247 

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years, you may submit an estimate of projected actual emissions along with the actual emissions from 

the preceding calendar year and the rationale for the projected actual emissions. For a source that has 

not operated for an entire year, the actual emissions are the estimated annual emissions for the current 

calendar year. 

3. The emission estimates can be based upon actual test data or, in the absence of such data, 

upon procedures acceptable to the Reviewing Authority. The following procedures are 

generally acceptable for estimating emissions from air pollution sources: 

(i) Source-specific emission tests; 

(ii) Mass balance calculations; 

(iii) Published, verifiable emission factors that are applicable to the source. (i.e., manufacturer 

specifications). 

(iv) Other engineering calculations; or 

(v) Other procedures to estimate emissions specifically approved by the Reviewing Authority. 

4. Guidance for estimating emissions can be found at http://www.epa.gov/ttn/chief/efpac/index.html.