EPA Form 7610 -5 ( Revised 12

- 200 9) The Acid Rain Program and CAIR Trading Programs (CAIR NO X Annual, CAIR SO 2 , and CAIR NO X Ozone Season) regulations require any person, company, or organization wishing to open a general account for the purpose of holding and transferring allowances to submit a completed G eneral Account

form

. You also may use this form to change the information previously submitted for a general a ccount, such as the identity of the authorized account representative. In such cases, enter your allowance account identification number in the space provided at the top of the form. Note: A compliance account can only be established, and information concerning a compliance account can only be changed, by submitting a Certificat e of Representation form

.

If you need assistance, call the Clean Air Markets Hotline at 202

- 343

- 9620.

STEP 2 The owners may choose an alternate to act on behalf of the Authorized Account Representative.

STEP 3 Identify all parties with an ownership interest in the allowances held in this account. All of these parties must be subject to a binding agreement authorizing the representation of the account by the authorized account representative, and, if applicable, the alternate authorized account
represent ative, identified in Steps 1 and 2. If you (the authorized account representative) are the only person with an ownership interest in the allowances held in the account, list your name

here. If additional space is needed, please attach a separate sheet of paper.

STEP 4 If you are establishing a general account, both the authorized account representative and the alternate (if any) must sign and date the certificatio ns

. You are encouraged to use the CAMD Business System (CBS) to submit general account information online. To register for CBS, go to https://camd.epa.gov/loginrequest/index.cfm.

For more information see the applicable rule:

Acid Rain: 40 CFR 73.31

CAIR NO X Annual: 40 CFR 96.151 or 97.151 or the applicable State rule

CAIR SO 2 : 40 CFR 96.251 or 97.251 or the applicable State rule

CAIR NO X Ozone Season: 40 CFR 96.351 or 97.351 or the applicable State rule

Paperwork Burden Estimate

The public reporting and recordkeeping burden for this collection of information is estimated to average 10 hours per response. Burden means the 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 technology 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 previo usly 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 n ot conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

Send comments on the Agency’s need for this information, the accuracy of the provided burden estimate s, 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 7610 -5 ( Revised 12

- 200 9) Page 1 United States Environmental Protection Agency OMB Nos. 2060

- 0258 and 2060

- 0570 Approval expires 11/30/2012 

# G eneral Account Form

For more information, see instructions.

This submission is: New (to open a new general account)
Revised (to revise information on an existing general account)

Thi s account is authorized to hold allowances in these programs:

Acid Rain/CAIR SO 2 Trading

CAIR NO X Ozone Season Trading

CAIR NO X Trading

If you are opening a new allowance account, complete all steps in this form. If this is a
revised submission, ente r your account # and account name and complete Step 4 to authorize the change of information. Only the authorized account representative or

alterna te authorized account representative can authorize the change.

Account #

Account Name

Name Title

Company Name

Address

Phone Number Fax Number

E- mail Address STEP 1 Enter requested

information for the

authorized account representative.

STEP 2 Enter requested

information for the

alternate authorized account representative (r equired only if you want the general account

to have an alternate

au thorized account representative ). Name Title

Company Name

Address

Phone Number Fax Number

E

- mail AddressEPA Form 7610 -5 ( Revised 12

- 200 9) Page 2 STEP 3

Enter the names of all parties (persons or companies) subject to the binding agreement authorizing your representation of the

account. Name

Name

Name

Name

Acid Rain Program

I certify that I was selected under the terms of an agreement that is binding on all persons who have an ownership interest with respect to allowances held in the Allowance Tracking System account. I certify that I have all necessary authority to carry out my duties and responsibilities on behalf of the persons with an ownership interest and that they shall be fully bound by my actions, inactions, or submissions under 40 CFR Part 73. I am authorized to make this submission on behalf of the persons with an ownership interest for whom this

submission is made.

I certify under penalty of law that I have personally examined, and am familiar with, the

statements and information 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, accurate, and complete. I am aware that there are significant penalties for submitting false statements and information or omitting material information, including the possibility of fine or imprisonment for violations.

Clean Air Interstate Rule (CAIR) NO X Annual Trading Program

I certify that I was selected as the CAIR authorized account representative or the alternate CAIR authorized account representative, as applicable, by an agreement that is binding on all persons who have an ownership interest with respect to CAIR NO X allowances held in the general account. I certify that I ha ve all the necessary authority to carry out my duties and responsibilities under the CAIR NO X Annual Trading Program on behalf of such persons and that each such person shall be fully bound by my representations, actions, inactions, or submissions and by any order or decision issued to me by the Administrator or a court regarding the general account.

I am authorized to make this submission on behalf of the persons having an ownership interest with respect to the CAIR NO X allowances held in the general acco unt. I certify under penalty of law that I have personally examined, and am familiar with, the statements and information 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, accurate, 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.

Clean Air Interstate Rule (CAIR) SO 2 Trading Program

I certify that I was selected as the CAIR authorized account representative or the alternate CAIR authorized account representative, as applicable, by an agreement that is binding on all persons who have an ownership interest with respect to CAIR SO 2 allowances held in the general account. I certify that I have all the necessary authority to carry out my duties and responsibil ities under the CAIR SO 2 Trading Program on behalf of such persons and that each such person shall be fully bound by my representations, actions, inactions, or submissions STEP 4

Read the certifications and sign and date.EPA Form 7610 -5 ( Revised 12

- 200 9) Page 3 and by any order or decision issued to me by the Administrator or a court regarding the general

account.

I am authorized to make this submission on behalf of the persons having an ownership interest with respect to the CAIR SO 2 allowances held in the general account. I certify under penalty of law that I have personally examined, and am familiar with, the statements and information 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, accurate, 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 imprisonmen t.

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

I certify that I was selected as the CAIR authorized account representative or the alternate CAIR authorized account representative, as applicable, by an agreement that is binding on all persons who have an ownership interest with respect to CAIR NO X Ozone Season allowances held in the general account. I certify that I have all the necessary authority to carry out my duties and responsibilities under the CAIR NO X Ozone Season Trading Program on behalf of such persons and that each such person shall be fully bound by my representations, actions, inactions, or submissions and by any order or decision issued to me by the Administrator or a court regarding the general account.

I am authorized to make this submission on behalf of the persons having an ownership interest with respect to the CAIR NO X Ozone Season allowances held in the general account. I certify under penalty of law that I have personally examined, and am familiar with, the statements and information 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, accurate, 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 (Au thorized Account Representative) Date

Signature (Alternate Authorized Account Representative, if any) DateSTEP 5 (Optional) Respond to the questions by marking all appropriate boxes

. (EPA

will use this information for program evaluation purposes onl y.) Is the authorized account representative employed by an allowance brokerage firm?

No

Yes (if yes, please mark all boxes that apply)

This account will be used to transfer allowances between cl ients

This account will be used to hold allowances for investment purposes

This account will be used for other purposes

What types of business are represented by the owner(s) of allowances in this account (mark all boxes

that apply)?

Utility

Non

- Utility Generators of Electricity

Industrial Boiler

Fuel Supplier

_______ Coal

_______ Oil

_______ Gas _______ Other

Pollution Control Equipment Manufacturer or distributor

Public Interest Group

_______ Consumer _______ Other

_______ Environmental

Submission

Information Other

─────────────────────────────── ▸

Mail to the following address:

By regular/certified mail:

U.S. Environmental Protection Agency Clean Air Markets Division (6204J) Attn: Allowance Tracking System 1200 Pennsylvania Avenue, NW Washington, DC 20460 Or overnight mail:

U.S. Environmental Protection Agency Clean Air Markets Division (6204J) Attn: Allowance Tracking System 1310 L Street, NW Second Floor, Office 202B Washington, DC 20005 (202) 343

- 9168

EPA Form 7610 -5 ( Revised 12

- 200 9) Page 4