United States Environmental Protection Agency

Acid Rain and CAIR Program s OMB Nos. 2060

- 0258 and 2060

- 0570

Approval Expires 11/31/2012



# Certifica te of Representation

Page 1

For more information, see instructions and 40 CFR 72.24; 40 CFR 96.113, 96.213, or 96.313 , or a comparable state regulation under the C lean Air I nterstate R ule (CAIR) NO X Annual, SO 2 , and NO X Ozone Season Trading Programs or 40 CFR 97.113, 97.213, or 97.313.

This submission is: 

##  New 

##  Revised (revised submissions must be complete; see instructions) FACILITY ( SOURCE)

INFORMATION

STEP 1

Provide

information for
the facility
(source)

. Facility (Source) Name State Plant Code

County Name

Latitude Longitude

STEP 2

Enter requested

information for

the
designated
representative. Name Title

Company Name

Address

Phone Number Fax Number

E- mail address

STEP 3

Enter requested

informati on for

the

alternate
designated
representative. Name Title

Company Name

Address

Phone Number Fax Number

E- mail address

EPA Form 7610

- 1 ( Revised 12- 2009 )Facility (Source) Name (from Step 1) Certificate of Representation

- Page 2

Page 

##  of 

## 

UNI T INFORMATION

STEP 4: Complete one page for each unit located at the facility identified in STEP 1 (i.e., for each boiler, simple cycle combustion turbine, or combined cycle combustion

turbine ) Do not list duct burners. Indicate each program to which the unit is subject, and enter all other unit

- specific information, including the name of each owner and operator of the unit and the generator ID number and nameplate capacity of each generator served by the unit

. If the unit i s subject to a program, then the facility (source) is also subject. (F or units subject to the NO X Budget Trading Program, a separate "A ccount Certificate of R epresentation " form must be submitted to meet requirements under that program .)

Applicable Progr am(s): 

##  Acid Rain 

##  CAIR NO X Annual 

##  CAIR SO 2 

##  CAIR NO X Ozone Season

Unit ID# Unit Type Source Category

NAICS Code Generator ID Number Acid Rain Nameplate CAIR Nameplate
(Maximum 8 characters) Capacity (MWe) Capacity (MWe)

Date unit began (or will begin) serving any generator producing electricity for sale ( including test generation) (mm/dd/yyyy): Check One:

Actual 

## 

Projected 

## 

Company Name: 

##  Owner


##  Operator

Co mpany Name: 

##  Owner


##  Operator

Company Name: 

##  Owner


##  Operator

Company Name: 

##  Owner


##  Operator

Company Name: 

##  Owner


##  Operator

EPA Form 7610

- 1 ( Revised 12- 2009 )Facility (Source) Name (from Step 1) Certificate of Representation

- Page 3

STEP 5: Read the a ppropriate certification statements

, sign, and date.

Acid Rain Program

I certify that I was selected as the designated representative or alternate designated representative (as applicable) by an agreement binding on the owners and operators of the affected source and each affected unit at the source (i.e., the source
and each unit subject to the Acid Rain Program, as indicated in " Applicable Program(s) " in Step 4).

I certify that I have all necessary authority to carry out my duties and responsibilities under the Acid Rain Program on behalf of the owners and operators of the affected source and each affected unit at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions.

I c ertify that the owners and operators of the affected source and each affected unit at the source shall be bound by any

order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit.

Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, an affected unit

, or where a utility or industrial customer purchases power from an affected unit under a life

- of

- the

- unit, firm power contractual arrangement, I certify that:

I have given a written notice of my selection as the designated representative or alternate designated representative (as applicable) and of the agreement by which I was selected to each owner and operator of

the affected source and each affected unit at the source; and

Allowances, and proceeds of transactions involving allowances, will be deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation or entitlement, except that, if such multiple holders have expressly provided for a different distribution of allowances, allowances and proceeds of transactions involving allowances will be deemed to be held or distributed in accordance with

the contract.

Clean Air Interstate Rule ( CAIR ) NO X Annual Trading Pr ogram

I certify that I was selected as the CAIR designated representative or alternate CAIR designated representative (as applicable), by an agreement binding on the owners and operators of the CAIR NO X source and each CAIR NO X unit at the source (i.e., t he source and each unit subject to the CAIR NO X Annual Trading Program, as indicated in " Applicable Program(s) " in Step 4).

I certify that I have all necessary authority to carry out my duties and responsibilities under the CAIR NO X Annual Trading Program on behalf of the owners and operators of the CAIR NO X source and each CAIR NO X unit at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions.

I certify that the owners and operators of the CAIR NO X source and each CAIR NO X unit at the source shall be bound by any order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit.

Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CAIR NO X unit

, or where a utility or industrial customer purchases power from a CAIR NO X unit under a life

- of

- the

- unit, firm power contractual arrangement, I certify that:

I have given a written notice of my selection as the CAIR designated representative or alternate CAIR designated representative (as applicable) and of the agreement by which I was selected to each owner and operator of the CAIR NO X source and each CAIR NO X unit at the source; and

CAIR NO X allowances and proceeds of transactions involving CAIR NO X allowances will be deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation or entitlement, except that, if such multiple holders have expressly provided for a different distribution of CAIR

NO X allowances by contract, CAIR NO X allowances and proceeds of transactions involving CAIR NO X allowances will be deemed to be held or distributed in accordance with the contract.

EPA Form 7610

- 1 ( Revised 12- 2009 )Facility (Source) Name (from Step 1) Certificate of Representation

- Page 4

Page 

##  of 

## 

Clean Air Interstate Rule ( CAIR ) SO 2 Trading Program

I certify that I was selected as the CAIR designated representative or alternate CAIR designat ed representative (as applicable), by an agreement binding on the owners and operators of the CAIR SO 2 source and each CAIR SO 2 unit at the source (i.e., the

source and each unit subject to the SO 2 Trading Program, as indicated in " Applicable Program(s) " i n Step 4).

I certify that I have all necessary authority to carry out my duties and responsibilities under the CAIR SO 2 Trading Program, on behalf of the owners and operators of the CAIR SO 2 source and each CAIR SO 2 unit at the source and that each such o wner and operator shall be fully bound by my representations, actions, inactions, or submissions.

I certify that the owners and operators of the CAIR SO 2 source and each CAIR SO 2 unit at the source shall be bound by any order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit.

Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CAIR SO 2 unit

, or where a utility or industrial customer purchases power from a CAIR SO 2 unit under a life

- of

- the

- unit, fir m power contractual arrangement

, I certify that:

I have given a written notice of my selection as the CAIR designated representative or alternate CAIR designated representative (as applicable) and of the agreement by which I was selected to each owner and operator of the CAIR SO 2 source and each CAIR SO 2 unit at the source; and

CAIR SO 2 allowances and proceeds of transactions involving CAIR SO 2 allowances will be deemed to be held or distributed in proportion to eac h holder's legal, equitable, leasehold, or contractual reservation or entitlement, except that, if such multiple holders have expressly provided for a different distribution of CAIR SO 2 allowances by contract, CAIR SO 2 allowances and proceeds of transactions involving CAIR SO 2 allowances will be

deemed to be held or distributed in accordance with the contract.

Clean Air Interstate Rule ( CAIR ) NO X Ozone Season Trading Program

I certify that I was selected as the CAIR designated representative or alternate CAIR designated representative (as applicable), by an agreement binding on the owners and operators of the CAIR NO X Ozone Season source and each CAIR NO X Ozone Season unit at the source (i.e., the source and each unit subject to the CAIR NO X Ozone Season Trading Program, as indicated

in " Applicable Program(s) " in Step 4).

I certify that I have all necessary authority to carry out my duties and responsibilities under the CAIR NO X Ozone Season Trading Program on behalf of the owners and operators of the C AIR NO X Ozone Season source and each CAIR NO X Ozone Season unit at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or

submissions.

I certify that the owners and operators of the CAIR NO X Ozo ne Season source and each CAIR NO X Ozone Season unit shall be bound by any order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit.

Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CAIR NO X Ozone Season unit, or where a utility or industrial customer purchases power from a CAIR NO X Ozone Season unit under a life

- of

- the

- unit, firm power contractual arrangement, I certify that:

I have given a wri tten notice of my selection as the CAIR designated representative or alternate CAIR designated representative (as applicable) and of the agreement by which I was selected to each owner and operator of the CAIR NO X Ozone Season source and each CAIR NO X Ozone Season unit; and

CAIR NO X Ozone Season allowances and proceeds of transactions involving CAIR NO X Ozone Season allowances will be deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation or entitlement, except that, if such multiple holders have expressly provided for a

different distribution of CAIR NO X Ozone Season allowances by contract, CAIR NO X Ozone Season allowances and proceeds of transactions involving CAIR NO X Ozone Season allowances will be deem ed to be held or

distributed in accordance with the contract.

EPA Form 7610

- 1 ( Revised 12- 2009 )Facility (Source) Name (from Step 1) Certificate of Representation

- Page 5

Page 

##  f 

## 

General

I am authorized to make this submission on behalf of the owners and operators of the source or units for which the submission is made. I certify under penalty of law that I have personally examined, and am familiar with, the statements and informatio n
submitted in this document and all its attachments. Based on my inquiry of those individuals with primary responsibility for obtaining the information, I certify that the statements and information are to the best of my knowledge and belief true, acc urate, and complete. I am aware that there are significant penalties for submitting false statements and information or omitting required statements and information, including the possibility of fine or imprisonment.

Signature ( Designated Representative ) Date

Signature ( Alternate Designated Representative ) Date

EPA Form 7610

- 1 ( Revised 12-2 009 )1 

## Instructions for the Certificate of Representation

Note : The Certificate of Representation information can be submitted online through the

CAMD Business System (CBS) at https://camd.epa.gov/cbs/index.cfm

. You must have a user

ID and password. If you need a user ID and password, or if you have questions about CBS, contact

Laurel DeSantis at desantis.laurel@epa.gov or (202) 343

- 9191, or Alex Salpeter at
salpeter.alex@epa.gov or (202) 343

- 9157.

Any reference in these instructions to the Designated Representative means the Acid Rain Designated Representative and/or CAIR Designated Representative, as applicable. Any reference

to the Alternate Designated Representative means the Alternate Acid Rain Designated

Representative and/or the Alternate CAIR Designated Representative

, as applicable. As reflected in

this form, the Acid Rain Designated Representative, the CAIR Designated Representative for a
facility (source) mus t be the same individual, and the Alternate Acid Rain Designated

Representative and the Alternate CAIR Designated Representative for a facility (source) must be the

same individual

.

Please type or print. Submit one copy of page 2 for each unit subject to the Acid Rain Program or a
CAIR Tradi ng Program at the facility (source) , and indicate the page order and total number of
pages ( e.g. , 1 of 4, 2 of 4, etc.) in the boxes in the upper right hand corner of page 2

. A Certificate
of Representation amending a n earlier submission supersedes the earlier submission in its
entirety and must therefore always be complete . Submit one Certificate of Representation form

with original signature(s). NO FIELDS SHOULD BE LEFT BLANK. For assistance, contact Laurel

DeSanti s at desantis.laurel@epa.gov or (202) 343

- 9191

.

STEP 1
(i) A Plant Code is a 4 or 5 digit number assigned by the Department of Energy = s (DOE) Energy
Information Administration (EIA ) to facilities that generate electricity. For older facilities, " Plant

Code " is synonymous with " ORISPL " and " Facility " codes. If the facility generates electricity but no Plant Code has been assigned, or if there is uncertainty regarding what the Plant Code is, contact

EIA at (202) 586 -4 325 or (202) 586

- 2402 . For facilities that do not produce electricity, use the
facility identifier assigned by EPA (beginning with " 88 " ). If the facility does not produce electricity
and has not been assigned a facility identifier, contact Laurel DeSantis at desantis.laurel@epa.gov

or (202) 343

- 9191

.

(ii) Enter the latitude and longitude representing the location of the facility in degree decimal format.

Note that coordinates MUST be submitted in decimal degree format; in this format minutes and seconds are

represented as a decimal fraction of one degree. Therefore, coordinates containing degrees, minutes, and

seconds must first be converted using the formula:

decimal degrees = degrees + (minutes / 60) + (seconds / 3600)

Example:

39 degrees, 15 minutes, 25 seconds = 39 + (15 / 60) + (25 / 3600) = 39.2569 degrees2 STEPS 2 & 3

The Designated Representative and the Alternate Designated Representative must be individuals
(i.e., natural perso ns) and cannot be a company. Enter the company name and address of the

representative as it should appear on all correspondence. If an email address is provided, most

correspondence will be emailed. Although not required, EPA strongly encourages owners and
operators to designate an Alternate Designated Representative to act on behalf of the
Designated Representative

.

STEP 4
(i) Complete one page for each unit s ubject to the Acid Rain Program or a CAIR Trading Program

, and indicate the program (s) to w hich the unit is subject

. (F or units subject to the NO X Budget
Trading Program, a separate "A ccount Certificate of Representation " form must be submitted to
meet requirements under that program .) Identify each unit at the facility by providing the approp riate unit identification number, consistent with the identifiers used in previously submitted Certificates of
Representation (if applicable) and with submissions made to DOE and/or EIA. Do not list duct

burners . For new units without identification numb ers, owners and operators must assign identifiers
consistent with EIA and DOE requirements. Each submission to EPA that include s the unit identification number(s) (e.g., monitoring plans and quarterly reports) should reference those unit

identification numbers in exactly the same way that they are referenced on the Certificate of

Representation. Do not identify units that are not subject to the above

- listed programs but are part
of a common monitoring configuration with a unit that is subject to any of these programs. T o identify units in a common monitoring configuration that are not subject to any of these programs,
call the CAMD Hotline at (202) 343

- 9620, and leave a message under the " CEM S" submenu.

(ii) Identify the type of unit using one of the following abbreviations:

Boilers Boilers Turbines

AF

BFB

C

CB

CFB

DB

DTF

DVF Arch

- fired boiler

Bubbling fluidized bed

boiler

Cyclone boiler

Cell burner boiler

Circulating fluidized

bed boiler

Dry bottom wall

- fired

boiler

Dry bottom turbo

- fired

boiler

Dry bottom vertically

fired boiler OB

PFB

S

T

WBF

WBT

WVF Other boiler

Pressurized

fluidized bed boiler

Stoker

Tangentially

- fired

boiler

Wet bottom wall

fired boiler

Wet bottom turbo

fired boiler

Wet bottom
vertically

- fired boiler CC

CT

OT

Others

ICE

KLN

PRH Combined cycle

Combustion turbine

Other turbine

Internal combustion
engine

Cement kiln

Refinery process

heater

If there is uncertainty about how a unit should be characterized, contact Robert M iller at miller.robertl@epa.gov or (202) 343

- 9077

.3 (iii) Indicate the source category description that most accurately describes the purpose for which

the unit is operated by entering one of the following terms

. If none of these descriptions applies to

your unit, contact Robert Miller at miller.robertl@epa.gov or (202) 343

- 9077.

Automotive Stampings Industrial Boiler Petroleum Refinery

Bulk Industrial Chemical Indust rial Turbine Portland Cement Plant

Cement Manufactur ing Institutional Pulp and Paper Mill Cogeneration Iron and Steel Small Power Producer

Electric Utility Municipal Waste Combustor Theme Park

(iv) Provide the primary North American Industrial Classifica tion System (NAICS) code that most
accurately describes the business type for which the unit is operate d . If unkno wn, go to http://www.census.gov for guidance on how to determine the proper NAICS code for the unit

.

(v) Enter the date the unit began (or will begin) serving any generator producing electricity for sale

, including test generation

. Enter this date and check the " actual " box for an y unit that has begun to serve a generator producing electricity for sale as of the date of submission of this form. ( This
information should be provided even if the unit does not currently serve a generator producing
electricity for sale. ) For any unit that will begin , but ha s not begun as of the date of submission of

this fo rm, to serve a generator producing electricity for sale , estimate the future date on which the

unit will begin to produce electricity for sale and check the " projected " box. When the actual date is

established , r evise the form accordingly by entering the actual date and checking the " actual " box.

Enter " NA " if the unit has not ever served, is not currently serving, and is not projected to serve, a
generator that producing electricity for sale. You are strongly encouraged to use the CAMD
Business System t o update information regarding when a unit begins serving a generator
producing electricity for sale.

I f you have questions regarding this portion of the form, contact Robert Miller at miller.robertl@epa.gov or (202) 343

- 9077.

(vi) For a unit subject to the Acid Rain Program or a CAIR Trading Program, that , as of the date of

submission of this form, serve s one or more generator s (whether or not the generator produces
electricity for sale), indicate the generator ID number and the nameplate capacity (in MWe) of each
generator served by the unit. A unit serves a generator if it produces, or is able to produce, steam,
gas, or other heated medium for generating electricity at that generator. For combined cycle un its,
report separately the nameplate capacit ies of the generators associated with the combustion turbine
and the steam turbine. Please ensure that the generator ID numbers entered are consistent with

those reported to the EIA.

The definitions of " nameplate capacity " under the Acid Rain Program an d under the CAIR Program
differ slightly. Therefore

, for a unit subject to the Acid Rain Program and any CAIR Program, the
nameplate capacity for the same generator under the Acid Rain Program and under the CAIR

P rogram may differ in certain limited circu mstances. Specifically, for a unit subject to the Acid Rain
Program, the nameplate capacity of a generator

, if listed in the National Allowance Database
(" NADB ")

, is not affected by physical changes to the generator after initial installation that result in
an increase in the maximum electrical generating output that the generator is capable of producing

. Otherwise, for a unit subject to the Acid Rain Program or a CA IR P rogram, the nameplate capacity
of a generator is affected by physical changes to the generator after initial installation that result in
an increase in the maximum electrical generating output that the generator is capable of producing

. In such a case, the higher maximum electrical generating output number in MWe should be reported

in the nameplate capacity column. Enter " NA " if , as of the date of submission of this form, the un it
does not serve a generator

.

See the definition of " nameplate capacity " at 40 CFR 72.2, 96.102, 97. 102, 96.202, 97.202, 96.302,

and 97.302, as applicable. The NADB is located at the CAMD website at4 http://www.epa.gov/airmarkets/trading/allocations.html

. I f you have questions regarding nameplate

capacity, c ontact Robert Miller at miller.robertl@epa.gov or (202) 343

- 9077 ; if you have questions
regarding the NADB, contact Craig Hillock at hillock.craig@epa.gov or (202) 343

- 9105

.

(vii) Enter the company name of each owner and operator in the " Company Name " field. Indicate

whether the company is the owner, operator, or both. For new units, if the operator of a unit has not
yet been chosen, indicate that the owner is both the owner and operator and submit a revised form

when the operator has been selected within 30 days of the effective date of the selection. EPA must

b e notified of changes to owners and operators within 30 days of the effective date of the change. You are strongly encouraged to use the CAMD Business System to provide updated

information on owners and operators

.

STEP 5
Read the appropriate certifica tion statements, sign, and date.

Mail this form to:

For regular /certified mail: For overnight mail:

U.S. Environmental Protection Agency U.S. Environmental Protection Agency

Clean Air Markets Division (6204J) Clean Air Markets Division (6204J)

Atten tion: Designated Representative Attention: Designated Representative

1200 Pennsylvania Avenue, NW 1310 L Street, NW
Washington, DC 20460 Second Floor
Washington, DC 20005

(202) 343

- 9191

Submit this form prior to making any other submissions under the Acid Rain Program, CAIR

NO X Trading Program, CAIR SO 2 Trading Program, or CAIR NO X Ozone Season Trading

Program

. Submit a revised Certificate of Representation when any information in the existing
Certificate of Representation changes. You are strongly encouraged to use the CAMD Business

System to provide updated information.

Paperwork Burden Estimate

The public reporting and record keeping burden for this collection of information is estimated to

average 15 hours per response annually. Burden means t he total time, effort, or financial resources

expended by persons to generate, maintain, retain, or disclose or provide information to or for a

Federal agency. This includes the time needed to review instructions; develop, acquire, install, and

utilize te chnology and systems for the purposes of collecting, validating, and verifying information,

processing and maintaining information, and disclosing and providing information; adjust the existing

ways to comply with any previously applicable instructions and requirements; train personnel to be

able to respond to a collection of information; search data sources; complete and review the

collection of information; and transmit or otherwise disclose the information. An agency may not

conduct or sponsor, and a pe rson is not required to respond to, a collection of information unless it
displays a currently valid OMB control number.5 Send comments on the Agency's need for this information, the accuracy of the provided burden

estimates, and any suggested methods fo r 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.