OMB Control No. 2060-0003 Approval expires 04/30/2012

EPA Form No. 5900-246 United States Environmental Protection Agency Program
Address

Phone
Fax
Web address Reviewing Authority Program
Address

Phone
Fax
Web address

FEDERAL MINOR NEW SOURCE REVI EW PROGRAM IN INDIAN COUNTRY



### Application For Synthetic Minor Limit
(Form SYNMIN)

Please submit information to:

[Reviewing Authority
Address Phone]

A. GENERAL INFORMATION
Company Name Source Name

Company Contact or Owner Name Title

Mailing Address

Email Address

Telephone Number Facsimile Number

B. ATTACHMENTS For each criteria air pollutant, ha zardous air pollutant and for all emission units and air pollutantgenerating activities to be covered by a limitation, include the following:

Item 1 - The proposed limitation and a description of its effect on current actual, allowable and the potential to emit.

Item 2 - The proposed testing, monitoring, recordkeeping, and re porting requirements to be used to demonstrate and assure compliance with the proposed limitation.

Item 3 - A description of estimated efficiency of air pollu tion control equipment unde r present or anticipated operating conditions, including documentation of th e manufacturer specifications and guarantees.

Item 4 - Estimates of the Post-Change Allowable Emissions that would result from compliance with the proposed limitation, including all calculations for the estimates.

Item 5 – Estimates of the potential emissions of Greenhouse Gas (GHG) pollutants:OMB Control No. 2060-0003 Approval expires 04/30/2012

EPA Form No. 5900-246 Page 2 of 4

[ Disclaimers ] The public reporting and recordkeeping burden for this collection of information is estimated to average 6 hours per response. Send comments on the Ag ency’s need for this in formation, 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.



## Instructions

Use this form to provide general and summary information about the synthetic minor NSR source (source or plant) on Tribal lands and to indicate the emissions limitations requested. Submit this form once, in addition to FORM NEW, for each synthetic minor NSR source on
Tribal lands.

1. Who Can Request Federally-Enforceable Limi tations Under the Tribal NSR Authority?

The Tribal NSR Rule applies only to sources locat ed within the exterior boundaries of an Indian
reservation in the United States of America or othe r lands as specified in 40 CFR part 49, collectively referred to as “Indian country”. So, to use the aut hority in the Tribal NSR Rule to create federallyenforceable limitations, a source must be located w ithin Indian country. Land ownership status (for example, whether the land is owned by a Tribal member or whether the land is owned in fee or in trust)
does not affect how th e rule applies.

2. Who Might Want to Request Fed erally-Enforceable Limitations?

The primary reason for requesting federally-enforceable limitations is to avoid an otherwise applicable federal Clean Air Act program, rule or requireme nt. Many federal Clean Air Act programs use a source’s “potential to emit” (PTE) air pollution to determine which rules or requirements apply. A source’s PTE is based on the maximum annual ope rational (production, throughput , etc) rate of the source taking into consideration the capacity an d configuration of the equipment and operations. Emission or operational limits can al so be taken into consideration as maximums if they are federally enforceable. So, using a synthetic minor NSR permit to establish federally enforceable limitations can lower a source’s PTE and possibly allow the s ource to avoid certain federal Clean Air Act requirements.

Three examples of federal Clean Air Act programs th at use PTE to determine whether they apply are (1) the Prevention of Significant Deterioration (PSD) construction permitting program, (2) the Title V operating permit program, and (3) the Maximum Ac hievable Control Technology (MACT) program. For example, existing sources that are considered “major” for Title V (meaning they have the potential to emit air pollution at levels defined in that rule as “major”) must apply fo r a Title V operating permit. If a source accepts a federally- enforceable limitation through a synthetic minor NSR permit that reduces their PTE to below the “major” threshol d, and the source does not meet any of the other requirements that would trigger appl icability to the part 71 program, th en the source no longer needs a Title V operating permit. When planning for the c onstruction of a new source or expansion of an existing source, a source can also accept limitations on PTE (using a synthetic minor NSR permit) that
allow the source to avoid PSD. Limitations on PTE can similarly help a source to avoid new MACT standards that would otherwise apply to the source.OMB Control No. 2060-0003 Approval expires 04/30/2012

EPA Form No. 5900-246 Page 3 of 4 3. Section B. ATTACHMENTS

This section lists the information that must be at tached to the applicati on form for each requested limitation. The requested limitation(s) must be describe d for each affected emi ssions unit (or pollutantgenerating activity) and pollutant an d must be accompanied by the s upporting information listed on the form and described below. Note that applicability of many federal Clean Air Ac t requirements (such as Title V, PSD and MACT) is often based on source-wide emission levels of specific pollutants. In that case, all emissions units at a source and all pollutants regula ted by that given rule or regulation must be addressed by this section of the application form.

Item 1 – The requested limitation and its effect on act ual emissions or potential to emit must be presented in enough detail to document how the lim itation will limit the sour ce’s actual or potential emissions as a legal and practical matter and, if applicable, will allow the source to avoid an otherwise applicable requirement. The information presented mu st clearly explain how the limitation affects each emission unit and each air pollutant from that emissi on unit. Use the information provided in response to Item 4 below to explain how the limitation affect s emissions before and after the limitation is in
effect.

Item 2 – For each requested limitation, the application mu st include proposed testing, monitoring, recordkeeping and reporting that will be used to demonstrate and assure compliance with the limitation. Testing approaches shoul d incorporate and reference appr opriate EPA reference methods where applicable. Monitoring should describe the emi ssion, control or process parameters that will be relied on and should address frequenc y, methods, and quality assurance.

Item 3 – The application must include a description and estimated effici ency of air pollution control equipment under present or anticipated operating conditions. For control equipment that is not proposed to be modified to meet the requested limit, simply note that fact; however, for equipment that is proposed to be modified (e.g. im proved efficiency) or newly insta lled to meet the proposed limit,
address both current and future de scriptions and efficiencies. Incl ude manufacturer specifications and guarantees for each control device.

Items 4 – Any emission estimates submitted to the Re viewing Authority must be verifiable using currently accepted engineering criter ia. 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 factor s that are applicable to the source. (i.e., manufacturer specifications). (iv) Other engineering calculations; or (v) Other procedures to estimate emissions spec ifically approved by the Reviewing Authority.

Post-Change Allowable Emissions : A source’s allowable emissions fo r a pollutant is expressed in tpy and generally is calculated by multiplying the allowed hourly emissions rate in pounds per hour (lbs/hr) times allowed hours (which is the number of hours in a y ear) and dividing by 2,000 (which is the number of pounds in a ton).
Item 5 - New construction projects th at have the potential to emit GHG emissions of at least 100,000 tpy CO 2 e and 100 or 250 tpy on a mass basis, modifications at existing PSD facilities that increase GHG emissions by at least 75,000 tpy CO 2 e and minor sources that increase GHG emissions by at least 100,000 tpy CO 2 e and 100 or 250 tpy on a mass basis are subject to PSD permitting requirements, evenOMB Control No. 2060-0003 Approval expires 04/30/2012

EPA Form No. 5900-246 Page 4 of 4 if they do not significantly increase emissions of a ny other pollutant. As such, any requested limits to avoid PSD must take into account greenhouse gases.

Therefore, please include in your permit applica tion estimates of the pot ential emissions of the following pollutants. More information a bout GHG permitting and how to calculate CO 2 equivalents (CO 2 e), the mass emissions of each individual GHG adju sted for its Global Warming Potential (GWP) can be found at: http://epa.gov/nsr/ghgdocs/ghgpermittingguidance.pdf

1. Carbon dioxide (CO 2 ) 2. Methane (CH 4 ) and its CO 2 e 3. Nitrous oxide (N 2 O) and its CO 2 e 4. Hydrofluorocarbons (HFCs) and its CO 2 e 5. Perfluorocarbons (PFCs) and its CO 2 e 6. Sulfur hexafluoride (SF 6 ) and its CO 2 e