EPA Form No. XXXX-XXX 

EPA ICR No. 1230.27 

OMB Control No. 2060-0003 

Approval expires 4/30/2017 

United States Environmental Protection Agency

Program

Address

Phone

Fax

Web address

Reviewing Authority

Program

Address

Phone

Fax

Web address

FEDERAL IMPLEMENTATION PLAN FOR MANAGING AIR EMISSIONS FROM TRUE 

MINOR SOURCES ENGAGED IN OIL AND NATURAL GAS PRODUCTION IN INDIAN 

COUNTRY

Registration for New True Minor Oil and Natural Gas Sources and Minor 

Modifications at Existing True Minor Oil and Natural Gas Sources

Please submit information to: 

[Reviewing Authority

Address

Phone]

A. GENERAL SOURCE INFORMATION (See Instructions Below)

1. Company Name 2. Source Name

3. Type of Oil and Natural Gas Operation 4. New True Minor Source?  Yes  No

5. True Minor Source Modification?  Yes  No

6. NAICS Code 7. SIC Code

8. U.S. Well ID(s) or API Number(s) [if applicable]

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

[Disclaimer] 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.
EPA Form No. XXXX-XXX 

EPA ICR No. 1230.27 

OMB Control No. 2060-0003 

Approval expires 4/30/2017 

Page 2 of 7

B. CONTACT INFORMATION (See Instructions Below)

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
EPA Form No. XXXX-XXX 

EPA ICR No. 1230.27 

OMB Control No. 2060-0003 

Approval expires 4/30/2017 

Page 3 of 7

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. Indicate all requirements referenced in the Oil 

and Natural Gas FIP that apply/will apply to emissions units and air pollution generating activities at the 

source or proposed. Include statements indicating each emissions unit that is an emissions unit potentially 

subject to the requirements referenced in the FIP, but does not meet the definition of an affected facility 

under the referenced requirement, and therefore, is not subject to those requirements.

 For each emissions unit comprising the new source or modification, estimates of the 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.

 For each emissions unit comprising the new source or modification, 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
EPA Form No. XXXX-XXX 

EPA ICR No. 1230.27 

OMB Control No. 2060-0003 

Approval expires 4/30/2017 

Page 4 of 7

D. TABLE OF ESTIMATED EMISSIONS 

Provide in the table below estimates of the total actual and allowable (potential) emissions in tons

per year (tpy) for the following pollutants for all emissions units comprising the new source or 

modification.

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
EPA Form No. XXXX-XXX 

EPA ICR No. 1230.27 

OMB Control No. 2060-0003 

Approval expires 4/30/2017 

Page 5 of 7

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, or location that may 

contain one or more air pollution emitting units.

3. Type of Operation: Indicate the generally accepted name for the production segment operation (e.g., oil 

and gas well site, tank battery, compressor station).

4. New True Minor Source: [Per Indian Country Minor New Source Review Rule, 40 CFR 49.153].

5. True Minor Source Modification: [Per Indian Country Minor New Source Review Rule, 40 CFR 49.153].

6. NAICS (North American Industry Classification System): The NAICS Code for your oil and natural gas source

can be found at the following link for North American Industry Classification System:

http://www.census.gov/eos/www/naics/.

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 oil and natural gas source can be found at the 

following link for Standard Industrial Classification Codes: http://www.osha.gov/pls/imis/sic_manual.html.

8. U.S. Well ID or API Number: Provide the ID(s) for all oil and natural gas production wells associated with 

the facility, if applicable. Unique well identifier as assigned by the Federal or State oil and gas regulatory 

agency with primacy, using the American Petroleum Institute (API) Standard for number format (pre-2014) 

or the Professional Petroleum Data Management (PPDM) Association US Well Number Standard (2014-

present). Provide IDs for all oil and natural gas production wells associated with the facility, if applicable. 

May not be applicable for downstream production sources, such as compressor stations.

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.

11. Latitude & Longitude (11a. and 11b.): Provide latitude and longitude location(s) in decimal degrees, indicating the 

datum used in parentheses. These are GPS (global positioning system) coordinates. This information should 

be provided in decimal degrees with 6 digits to the right of the decimal point, indicating the datum used in 

parentheses (i.e., NAD 27, NAD 83, WGS 84 – WGS 84 is preferred over NAD 27). 
EPA Form No. XXXX-XXX 

EPA ICR No. 1230.27 

OMB Control No. 2060-0003 

Approval expires 4/30/2017 

Page 6 of 7

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 oil and 

natural gas production source being registered and the nature and extent of the air pollutants to be 

emitted.

D. Emissions

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

conditions, and air pollution control measures. For an emissions unit 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 unit will actually emit in coming 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 unit that has not operated for an entire year, the actual 

emissions are the estimated annual emissions for the current calendar year. 

2. Allowable Emissions (See also, Potential to Emit): Emissions rate of an emissions unit calculated 

using the maximum rated capacity of the unit (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:

 Any applicable standards as set forth in 40 CFR parts 60, 61 and 63;

 Any applicable Tribal or Federal Implementation Plan emissions limitation, including those 

with a future compliance date; or

 Any emissions rate specified as a federally enforceable permit condition, including those with 

a future compliance date.
EPA Form No. XXXX-XXX 

EPA ICR No. 1230.27 

OMB Control No. 2060-0003 

Approval expires 4/30/2017 

Page 7 of 7

3. Potential to Emit: The maximum capacity of an emissions unit to emit a pollutant under its 

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

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.

4. 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: 

 Unit-specific emission tests; 

 Mass balance calculations; 

 Published, verifiable emission factors that are applicable to the unit (i.e., manufacturer specifications);

 Other engineering calculations; or 

 Other procedures to estimate emissions specifically approved by the Reviewing Authority.

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