### FARRForms Attached: BurnPermit Forms for the Nez Perce Reservation and Umatilla Reservation 

### 40 CFR 49.132 Rule for general open burning pennits 40 CFR 49.133 Rule for agricultural burning pennits 40 CFR 49.134 Rule for forestry and silvicultural burning pennits Instructions andForms for Initial! AnnualSource Registration, Report of Relocation, Report ofClosure, and Report ofChange ofOwnership 

### 40 CFR49.138 Rule for the registration ofairpollution sources and the reporting ofemissions Instructions and Formfor Non-Tide V OperatingPermit 

### 40 CFR 49.139 Rule for non-Title Voperating pennitsForm Approved OMB 2060-0558 Approval Expires 513112011 

# oEPA United States Environmental Protection Agency Federal Air Rules for Reservations Region 10, OAWT 107 1200 6th Ave, Ste. 900 Seattle, WA 98101 Hotline: 800-424-4EPA Fax: 206-553-0110 www.epa.govlr10earthIFARR.htm Nez Perce Tribe ERWM - Air Quality Program P.O. Box 365,109 Lolo Street Lapwai, ID 83540 Phone: 208-843-9381 800-720-4089 Fax: 208-843-7411 www.nezperce.org 

### NEZ PERCE RESERVATION AIR QUALITY PERMIT: LARGE OPEN BURN INSTRUCTIONS, TERMS 

### & CONDITIONS A large open burn is**~reater** than 6feet in diameter ormore than 30feet of ditch bank orfence line**ve~etation.** Agricultural,forestry-related, andsmall burns require a differentpermit. Firefighter trainings require a large open burnpermit. Permitapplicants are responsible for following all instructions, terms andconditions regarding large open burning within the exteriorboundaries of the 

### 1863Nez Perce Reservation. Aftersending in theAir Quality PermitApplication (pages 

### 3-4) andreceiving approval to burn, 

### THIS SIGNED SHEETISYOURPERMIT (pages 1-2). Keep itavailable andprovide itupon request to the Nez Perce Tribe or U.S. EPA inspectors. 40 CFR 49.132 General Open BurningPermits Applicant Name Applicant Signature

INSTRUCTIONS Step 1. Complete pennit application, pages 3-4. Step 2. Submit completed pennit application to the Nez Perce Tribe (NPT)Air Quality Program at least one business day prior to the proposed bum date. Nez Perce Reservation Large Open Bum Pennits cost perpennit. Fees must be paid to the NPTAir QualityProgram prior to burning. Step 3. Call 208-843-9381 or 800-720-4089 to request to bum no laterthan 2:00 PM prior to the day ofthe desired bum. Applicants should leave a message providing the following infonnation: a. Name and phone number b. Bum name(s) ornumber(s) c. Date ofrequested bum d. Duration ofbum iflonger than one day e. Type and size ofbum (Large Open bum, numberofacres, footage orpiles) f. Special considerations, ifany (canyon rim, near highway, neara town) NOTE: Calling by 2:00 PM does not guarantee a next day bum approval. Step4. Ifapproved, applicants will receive a preliminary bum decision and ignition time by telephone by4:30 PM prior to the day ofthe approved bum. Ifnotapprovedto bum, applicants will not receive a call. Bum approvals will consider: a. The current and projected airquality conditions b. Proximity to sensitive areas (near towns, schools, roads, canyons rims) c. The orderofbumrequests received from applicants ("first come, first served" basis) d. Applicant'S record ofcompliance e. Other relevant factors Step 5. Ifthe preliminary bum decision changes due to poorair quality and/or updated forecast infonnation, the NPTAir Quality Program will call applicant by9:00AM the dayofthe bum. Step 6. As a condition ofthis pennit, within 24 hours afterthe bum. you must contact the NPTAir Quality Program with your post bum report. Applicants should provide the following infonnation: a. Name b. Date ofthe bum c. Start and end times ofthe bum d. The size ofany remaining unburned material (ifthe bum was not completed) EPA Form 7630-3 pg 1 of4 

### TillS IS \'OUR P1R.rvIIT: i\\adablc Wlllk 

### BurningFonn Approved OMB 2060-0558 Approval Expires 5/31/2011 TERMSAND CONDITIONS I. This permit is part ofa federal airquality program administered by the Nez Perce Tribe to control emissions of air pollutants and manage smoke for airqualitypurposes. These rules apply to any person within the exterior boundaries ofthe 1863 Nez Perce Indian Reservation. 2. Smoke impacts onpublic roads, schools, daycares, medical facilities, elderhomes and other sensitive people or areas must beprevented as a condition ofthis permit. Applicants must have Baggers stationed for bums that could potentially impact roadways. 3. Applicants must 

### be reachable by phone or other means ofcommunication during the bum. Ifneeded, the NPT or EPA will notify the applicant to discontinue lighting immediately. NOTE: The NPTAir Quality Program considers the following factors in the decision to shut down burning: a. Wind speed, direction, orsudden shifts b. Extended orhigh levels ofsmoke in the area c. Proximity ofsmoke to canyon rims, roadways, towns, houses, businesses, and sensitive populations d. Otherrelevant factors 4. Applicants are responsible for compliancewith any applicable bum safety requirements and must also obtain applicable fire safetypermits. Contactyour local fire district or sheriff's office for fire safety permit information. S. Residents and businesses are not permitted to bumstructures. Contact the NPTAir Quality Program for information regarding disposal ofthese materials. 6. Fire departments must obtain a Nez Perce ReservationAir Quality Large Open BumPermit to bum structures for the purpose oftraining firefighters in the methods offire suppression and fire-fighting techniques. Prior to igniting any structure, the fire department must ensure that the structure does not contain asbestos orasbestos-containing materials, orany stored prohibited items. NOTE: Fires are not allowed to smolder after the training session has terminated. 7. Large Open Burning is notpermitted during bumbans orairpollution episodes, orwhen the NPT or EPA determines thatburningwill cause an adverse impact to air quality. 8. The following materials are prohibited: Paper, paperproducts, or cardboard more than necessary to start a fire it is produced at a single-family residence orresidential site with four or fewer housing units; garbage; dead animals orparts ofdead animals;junked motor vehicles or any materials resulting from a salvage operation; tires orrubber materials orproducts; plastics, plastic products, orstyrofoam; asphalt orasphaltic material (roofing); tar, tarpaper, petroleum products, or paints; lumber or timbers treated with preservatives; construction or demolition waste; pesticides, herbicides, fertilizers, or other chemicals; insulated wire, batteries, orlight bulbs; mercury containing materials (thermometers, computers); asbestos or asbestos-containing materials; pathogenic or hazardous wastes; or any material that makes dark smoke ornoxious fumes otherthan vegetative materials. 9. Burningmustbe conducted in compliance with 40 CFR 49.131 General Open Burning and 49.132 General Open Burning Permits. lO. Burning conducted without permission from the NPT ERWM Air Quality Program and/or failure to follow the FARRpermitprocedures, terms and conditions are violations ofthe FARR and the federal CleanAirAct and are subject to penalties up to $37,SOO perday ofviolation.
The public reporting and recordkeeping burden for this collection of information is estimated to average 0.10 hour per response. Send comments on the Agency's need for this information, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use ofautomated 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 7630-3 THIS IS YOUR 

### PERJ\HT: Keep Available Whik HurnUll! pg 2 of4Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

# oEPA United States Environmental Protection Agency Federal Air Rules for Reservations Region 10, OAWT 107 1200 6th Ave, Ste. 900, Seattle, WA 98101 Hotline: 800-424-4EPA, Fax: 206-553-0110 www.epa.gov/r10earth/FARR.htm 

## -. Nez Perce Tribe**~\:.I\C£** "­ ERWM - Air Quality Program

# ~~~ P.O. Box 365, 109 Lolo Street, Lapwai, ID 83540**~** 

### .i Phone: 208-843-9381 800-720-4089 11"\, ot''' Fax: 208-843-7411**~** www.nezperce.org 

### NEZ PERCE RESERVATION AIR QUALITY PERMIT APPLICATION: LARGE OPEN BURN Complete this application and submit it at least one business day prior to the proposed burn date. Submit completed permit application to: Nez Perce Tribe, ERWM - Air Quality Program, P.O. Box 365, 109 Lolo Street, Lapwai, Idaho 83540 Phone: 800-720-4089 or 208-843-9381 Fax: 208-843-7411 Contact Information 1. Company Name 2. Date
3. Applicant Name 4. Primary Phone

5. Physical Address 6. Additional Phone

7. Mailing Address (if different from above) 8. Fax
9. City, State, Zip Code 10. County of Burn

11. Person Conducting the Burn (if different from applicant) 12. Phone of Person Conducting the Burn (if different from applicant) Description of Burn Location(s): 13. Burn Number 14. Township 15. Range 16. Section 

### 17. County 18. Fuel Type: I GrasslWeeds II Brush III Tree Limbs IV Large Logs V Other (Specify) 19. Number ofAcres, Footage or Piles (Indicate type that applies) 20. Average Size of Each Pile: (Length x Width x Height in feet)

Example: 1 35N 1W 7 Nez Perce 11/, /V 2 piles 10ftx 20ftx 15ft

EPA Form 7630-3 TillS IS YOUR ;\PPLJCATION: 

### Rl::tmn 1.0 

### lhe '\CI I\:nx Trihe ;\ir 

### OlldiilY Program pg 30f4Form Approved OMB 2060-0558 Approval Expires 5131/2011 Burn Information 21. Please locate and identify in the box below: Burn location(s). access roads, highways. houses, businesses or other sensitive areas that could be impacted by the burning to be conducted. Indicate distance and direction. When more than one burn is shown, label the burn using the burn number from page 3 ofthis application. Attach additional pages as needed to apply for multiple burns. A tract map, GPS map or other similar map may also be used.

22. Estimated duration of burn if longerthan one day:
23. Fire Safety Methods: Please indicate the measures you will take to prevent escaped burns and smoke danger: [Jwater availability [J hand tool availability [J heavy equipment availability [Jfire breaks or safety zones [Jf1aggers [J [Jother

____________ Applicants must also obtain applicable fire safety permits. Contact your local fire district or sheriff's office for fire safety permit information. 

### 24. Remarks:

APPLICANT'S STATEMENT (To be signed by the applicant) 25. I certify that the information provided as part ofthis application is true and accurate to the best of my knowledge and that I have read, understand, and agree to abide by the permit's terms and conditions. Name Name**-;-:-;--;---:--~** ___________ Date

___ ,<lignat!.",,,} (printed ortyped) pg 4 of4 EPA Form 7630-3 

### THIS YOUR APPL1C'ATION:**Rt:~turn** 

### to 

### the**~e7** 

### Perce 

### Tribe

### _________________ Permit Information 

# 2010 For Official Use Only. 

# SMALL BURN Date Location, Quantity and Type of Materials Burned for bums under6 ft in diameter or 30 ft or less ofditch bank or fence line vegetation 

## AIR QUALITY PERMITAPPLICATION
for the Nez Perce 

# &EPA Reservation 

# •

Land Owner Name (Print clearly)
Land Owner Signature
Name ofperson in charge of bums Physical Address or Legal Description of the bum(s) MailingAddress ofthe Land Owner Cityl StatelZip
Phone Numbers (Home and Alternates) 

### PART "A" of PERMIT: 

# n=iirouTan<fReturn-to-ftie-i
. i Nez Perce Tribe ERWM 

# !j I Notes:



### ___ 

# i 

# ! .-------------*---- 

### Air Quality Program

. . LL 

# .. 2010 SMALL BURN


# -**~** 

### 8. 

## AIR QUALITY PERMIT

... ::l o for the >­ Nez Perce .!! 

# &EPA Reservation ID 1:: 10 11. ID 1:: 10 11. 

# ! r::


### c o**~** 

## . Ii Q. 10 

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# .. 8. 

# .. ::l o >­ .!! c( 1::**~** " c( 1::**~** E .3 

### BURN PERMIT PROCESS 1. Submit a permit application at least

one business day before you want to burn. 

# •

2. Call 208-843-9381 or 800-720-4089 each day you want to burn to find out if it is a bum day. Bum only on BURN DAYS and DURING ALLOWED HOURS. 3. If it is a Burn Day, leave a message

with your name, phone number, whatyou are burning, and your fire safety precautions. 4. Each time you burn, record information in the log to the right.**~** 5. Burner must be prepared to prevent

and extinguish escaped bums. 6. Applicants must also obtain

applicable fire safety permits. Contact your local fire district or sheriff's office for fire safety information. CP •

### ~ 

### : PART "8" of PERMIT: ; I 

### r------------------------------------------.

## ~ 

## . !THIS IS YOUR PERMIT!**~** I

### ~ for calendar year 2010 : U 

# \I -----------------------------------------.**~** Keep available while burning. Name of Land Owner/Permitee
Land Owner Signature
Date 

### PERMIT LOG Date Location, Quantity and Type of Materials Burned

Burning conducted without permission from the NPT ERWM Air Quality Program and/or failure to follow the FARR permit procedures. terms and conditions are violations of FARR and the federal Clean AirAct and are subject to penalties up to $37,500 perday ofviolation.

## PERMIT CONDITIONS You May Burn You May NOT Burn ·Yard clippings, • Garbage brush, and other • Plastic vegetation • Hazardous .paper'rsaper waste produc s, or • Dead animals cardboard, or parts of dead only if: animals • Junked motor a fire • Used to start vehicles • Tires • Produced and • Asphalt

burned at a • Construction or single-family demolition waste residence • Treated lumber or timber • Produced and

burned at a • Pesticides or building with packaging four orfewer • Batteries apartments or • Light bulbs housing units • Asbestos • Pathological AND organisms Piles less than • Insulated wire 

### 6 feet in diam­ • Any material eter that makes dark smoke other than OR vegetative 30 feet or less materials of ditch bank or fence line vegetation For more information about the health effects of outdoor burning visit:

www.epa.gov/r10earth/FARR.htm Burning must be conducted in compliance with 40 CFR 49.131 General Open Burning and49.132 General Open BurningPennits Who to Contact for more Information: 

# &EPA www.nezperce.org 

### us EPA: 800-424-4EPA (FARR Hotline) www.epa.gov/r10earth/FARR.htm Smoke impacts on public roads, schools, daycares, medical facilities, elder homes and other sensitive people or areas must be prevented as a condition of this permit. Burning is not permitted during burn bans or air pollution episodes, or when the Nez Perce Tribe or EPAdetermines that burning will cause an adverse impact to air quality. This permit is part of a federal air quality program administered by the Nez Perce Tribe to control emissions of air pollutants and manage smoke for air quality purposes. These rules apply to any person within the exterior boundaries of the 1863 Nez Perce Indian reservation. The public reporting and recordkeeping burden for this collection ofinformation is estimated to average 0.10 hourperresponse. Send comments on the Agency's need for this information, the accuracy ofthe providedburden estimates, and anysuggested methods for minimizing respondentburden, including through the use ofautomated 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 numberin any co"espondence. Do not send the completed form to this address. EPA Form 7630-8 Approved OMB 2060-0558 Approval Expires 513112011 We appreciate your comments or feedback. Please write below.

Q: Why do I needa permit? A: Smoke from open burning is an air pollutant with effects on air quality and public health (especially for children and the elderly). Q: What are some alternatives to outdoor burning? A: Chipping and shredding vegetation for composting. Also, household items such as glass, plastics and paper can be recycled and should not be burned. Q: How can I burn more cleanly? A: Make sure your fuel is as dry as possible, separate the fire from damp ground and be sure there is enough draft to keep the fire burning hot. Q: Are there exceptions? A: Cultural, traditional and recreational fires are exempt and do not require a permit. 

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:>0."**8~p~** cs;!>",**~Cl~>-l** 0"'Form A roved OMB 2060-0558 A roval Ex ires 5/31/2011 Permit Number: (To Be Assigned by CTUIR OAQ) United States Environmental ProtectionAgency (EPA) Confederated Tribes ofthe Umatilla Indian Reservation (CTUIR) Federal Air Rules for Reservations (FARR) Office ofAir Quality (OAQ) Region 10, OAWT 107
..... CTUIR-DOSE Office ofAir Quality 1200 6th Ave., Ste. 900 _.

## EA~ 46411 Timine Way Seattle, WA 98101**~'** _., Pendleton, OR 97801 Hotline: 1-BOO-424-4EPA Phone: 541-429·7080 Fax: 206-553-0110 Fax: 541-429-7422 www.epa.gov/r10earth/FARR.htm hllp:llair.umalilla.nsn.us 

### UMATILLA INDIAN RESERVATION OFFICE OF AIR QUALITY PERMIT: LARGE OPEN BURN PERMIT INSTRUCTIONS, TERMS 

### & CONDITIONS A large open bum is a bum of non-prohibited materials that is greater than 6 feet in diameter or more than 60 feet offence line or ditch bank vegetation. Agricultural, forestry-related and small open burns require a different permit. Firefightertrainings require a large open bum permit. Permit applicants are responsible for following all instructions, terms and conditions regarding burning within the exterior boundaries ofthe Umatilla Indian Reservation. After sending in the Air Quality Large Open Burn PermitApplication (pages 3-4) and receiving 

# I approval to bum, KEEP THIS SIGNED SHEET AS YOUR PERMIT (pages 1-2). Have it available and provide it • upon request to the CTUIR Office ofAir Quality personnel or U.S. EPA inspectors,

40 CFR

### 49. 132 General Open Burning Permits PrintedApplicant Name: General Terms and Conditions • 1. Applicants must complete a permit application obtained from the CTUIR OAQ or online at , http://air.umatilla,nsn.us orwww.epa.gov/r10earth/FARR.htm

. 

# I a. Applications must be submitted to the CTUIR OAQ via fax or received in the mail at least 3 business days prior to desired burn date. b. CTUIR Large Open bum permits cost $0. c. Please apply early and ensure all documents are submitted to the OAQ prior to requesting permission to bum. 2. Applicants must request and receive bum approval from the CTUIR OAQ Personnel at: 541-429-7080. ,3. Applicants must shut down burns when requested to do so by the CTUIR OAQ or US EPA. CTUIR OAQ and

US EPA consider the following factors when deciding whether a bum should be shut down: a. Wind speed, direction, or sudden shifts b. Extended or extremely high levels of particulate matter in the atmosphere c. Fire safety and control d. Proximity to canyon rims, roadways, towns, houses, businesses, and other sensitive populations e. Other relevant factors ! 4. Applicants are responsible for conducting test burns if requested by CTUIR OAQ or EPA. 

## I \5. Applicants must make all required calls to the CTUIR OAQ as described in the instructions in this form. 

# I I Applicants must follow all procedures specified in this form and are responsible for following all procedures and

guidelines regarding open buming on the Umatilla Indian Reservation. 

### I 6. Smoke impacts on public roads, schools, daycares, medical facilities, elder homes and other sensitive people

or areas must be prevented as a condition ofthis permit. Applicants must have flaggers stationed for burns that could potentially impact roadways. 7. Burning must be conducted in compliance with 40 CFR 49.131 General Open Burning and 49.132 General Open Burning Permits. For a copy ofthese rules, please contact the CTUIR OAQ.



### Tll] IS YOUIZ PElZ\l[]' While Burning pgForm Approved OMB 2060-0558 Approval Expires 513112011 8. Burning conducted without authorization ofthe CTUIR OAQ and/orfailure to follow the FARR permit procedures are violations ofthe federal Clean AirAct and the FARR and are subject to penalties up to $37.500 per day ofviolation. 9. Applicants are responsible for compliance with any/all applicable bum safety requirements and must obtain**~ny/all** fire safety permits. Contact the Umatilla Tribal Fire Department (541-429-7801) forfire safety and permit information. 

### Instructions for Obtaining Authorization to Burn Application Process 1. Obtain. fill out, and submit a permit application via fax or mail to the CTUIR OAQ office. 2. Application will be reviewed for completeness and assigned a permit number. which will be included at the top ofthe permit section retained by applicant. 

### Procedures for the Day Priorto the Requested Burn Day 1. Applicant will be placed on the pending burn list once the application is submitted to CTUIR OAQ office and a permit number is issued by CTUIR OAQ. 2. Applicant will be contacted by the CTUIR OAQ staffwhen a preliminary burn day and burn time is determined. 3 The CTUIR OAQ staffwill review requested burns to determine recommendation for preliminary bum decisions. Burn priority will be as follows: a. Favorable conditions for sensitive areas (burn neartowns. roads, canyons) b. The preferred area to be burned (in terms offorecasted conditions) c. The order ofbum requests received from the applicants 

### Procedures for the Burn Day 1. Applicants will be called by the CTUIR OAQ by 9:00 AM to verify final burn decisions. 2. Applicants must be reachable by phone or other means ofcommunication during the day ofthe burn, should there be a change in the burn decision and it is necessary to cease all burning. NOTE: Ifapplicants are not reachable and continue burning. they are in violation ofthis permit. 3. All fires must be ignited and must be completely outwithin approved burn duration times. 

### Post-Burn Procedures 1. As a condition ofthis permit, within 24 hours after completing the burn. the applicant must contact the CTUIR OAQ with post-burn information and may leave a telephone message, email orfax with the following post-burn information: a. Name, as it is on application b. Date. time and durations ofthe burn(s) c. How the burn went and if it was completed d. Number ofacres or amount actually burned e. The size ofany remaining unburned material (if burn was not completed) NOTE: Ifan applicant does not submit the post-burn information, then the applicant will be out of compliance with permit conditions, and subject to enforcement action. 

### Applicant's Signature I certify that I have read, understand and have followed the instructions on this form and agree to abide by the permit's instructions. terms and conditions.
Applicant

## sSignature is required forpermit to bevalid. Date The public reporting and recordkeeping burden for this collection of information is estimated to average 0.35 hour per response. Send comments on the Agency's need for this information, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use ofautomated 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 tothis address. EPA Form 7630-12 

### Tlll'S [S YOUR PFRMIT: 

### K.cc j\\ailabk \Vhilc 

### Burning pg2of4Form Approved OMS 2060-0558 Approval Expires 5/31/2011 ForIntemal Use Only Permit Number: Date: Initials ofCTUIR Staff: United States Environmental Protection Agency (EPA) Federal Air Rules for Reservations (FARR) Confederated Tribes ofthe Umatilla Indian Reservation (CTUIR) Region 10, OAWT 107**~** 12006thAve.,Ste.900 .­

## EA~ Seattle, WA 98101 • ., Hotline: 1-800-424-4EPA Fax: 206-553-0110 www.epa.gov/r10earth/FARR.htm Office ofAir Quality (OAQ) CTUIR-DOSE Office ofAir Quality 46411 Timine Way Pendleton, OR 97801 Phone: 541-429-7080 Fax: 541-429-7422 htt :/Iair.umatilla.nsn.us 

### UMATILLA INDIAN RESERVATION OFFICE OF AIR QUALITY PERMIT: LARGE OPEN BURN PERMIT APPLICATION Complete this application and submit it at least three business days prior to the proposed burn date. Submit completed forms to: ClUIR-DOSE, Office ofAir Quality, 46411 limine Way, Pendleton, Oregon 97801. Phone: 541-429-7080, Fax: 541-429-7422. Contact Information 1. Company Name 2. Date
3. Applicant Name 4. Primary Phone
5. Physical Address 6. Additional Phone
7. Mailing Address (if different from above) 8. Fax and Email
9. City, State, Zip Code 10. County of Burn
11. Name of Person Conducting Burn (if different from applicant) 12. Phone of Person Conducting Burn (if different from applicant) Description of Burn Location 13. Burn Location:

14. Township: 15. Range: 16. Section: 17. Quartersection:

18. Indicate Type of Material to be Burned:

19. Indicate Amount of Material to be Burned by acres or piles (height x length x width in feet):

EPA Form 7630-12 

### TIllS IS YOUR APPLlC.'\TION: 

### Return to 

### the 

## crUIR OAO pg 3 of4Form Approved OMB 2060-0558 Approval Expires 5/31/2011

pg 4 of4 Burn Information 20. Map: Attach a printout or draw a map ofthe locations listed on this application to be burned, which shows local access roads, highways, residences, businesses or other areas that have potential to be impacted by the burning to be conducted. Indicate distance and direction. If more than one burn is shown, please identify the burn as you did on the front ofthis application. Attach additional pages as needed to apply for multiple burns. A tract map, GPS map or other similar map may also be used.

21. Burning Methods: Describe the burning method(s) to be used: Method: 0 Propane Torch 0 Other

____________________ 22. Fire Safety Methods: Please indicate the measures you will take to prevent escaped burns and smoke danger: o Water Truck 0 Hand Tools 0 Heavy Equipment 0 Fire Breaks and Safety Zones 0 Flaggers Other pertinent information: APPLICANT'S STATEMENT (To be signed by the applicant): I certify that the information provided as part of this application is true and accurate to the best of my knowledge and that I have read, understand and agree to abide by the permit's terms and conditions.

Signature of Applicant PrintedApplicant Name Date ForInternal Use Only Approved by: IDate: EPA Form 7630-12**THI~** 

### IS 'lOUR 

### APPLICATION: Reillrn 10 

### the 

### eTl1IR Of\()

# 2010 Permit Information For Official Use Only. 

# SMALL BURN OFFICE OFAIR QUALITYPERMITAPPLICATION Date Location/Quantity and

for bums under 6 ft in diameter or 60 ft or less Type of Materials to be ofditch bank or fence line vegetation Burned for the 

# &EPA Umatilla In.dian ReservatJon

Land Owner Name (Print clear1y)

Land Owner Signature
Name of person in charge of bums Physical Address ofthe bum Mailing Address ofthe Land Owner City! State! Zip
Phone Numbers (Home and Alternates) 

## PART "A" of 

## PERMIT: r---------·-----------__________________ , 

# ! Fill Out and Return to the

### ~ Notes: 

## !CTUIR Office ofAir Quality

## ~**~_______________________________________** , u. 0 

# + 2010 SMALL BURN OFFICE OFAIR QUALITY PERMITAPPLICATION for the 

# &EPA Umatilla In.dian Reservation

ai 

## i ­ IL C

# ~ C o

## ~ Ii Q. III 

# ...**~** Q) Q. 

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### « 1:: III • IL E 

# i BURN PERMIT PROCESS 1. Submit a permit application at least

one business day before you want to burn. 2. Call each day you want to burn to find out if it is a burn day. Burn only on BURN DAYS and DURING ALLOWED HOURS. Note: It is not necessary to call the day before you want to burn. 3. If it is a Burn Day, leave a message with your name, phone number, bum permit number and what you are burning. 4. Each time you burn, record information in the log to the right. -+ 5. Burner must be prepared to prevent and extinguish escaped burns
. 6. Applicants must also obtain

applicable fire safety permits. Contact CTUIR Fire Department: (541) 429-7801 7. Permit is good for the calendar year. 

### 11 I 

## PART "8" of 

## PERMIT: III "
.. j--"
.._-------- ------- --------------------- "-j 

### ;f I 

## lTHIS IS YOUR PERMITl

.. .. • t ..c: '

## ~ 

# V! Keep available while burning. 

# ! I CI

### ~~ _____

### -_------------------------------------! Permit Number (to be**as~gno;,d** by CTUIR OAQ) Name of Land Owner/Penmitee
Land Owner Signature
Date 

### PERMIT LOG Date Location/Quantity and Type of Materials to be Burned

Burning conducted without permission from the CTUIR OAQAir Quality Program and/or failure to follow the FARR permit procedures. terms and conditions are violations of FARR and the federal Clean AirAct and are subject to penalties up to $37.500 per day

## PERMIT CONDITIONS You May Burn -Yard clippings, brush, and other vegetation -Paper'rsaper produc s or cardboard; only if:

- Used to start afire
• Produced and

burned at a singlefamily residence
• Produced and

burned at a building with four orfewer apartments or housing units AND Piles less than 6 feet in diameter OR 60 feet or less of fence line or ditch bank vegetation You May NOT Burn • Garbage • Plastic • Hazardous waste • Dead animals

or parts of dead animals

- Junked motor

vehicles • Tires • Asphalt

- Construction or

demolition waste • Treated lumber or

timber • Pesticides or

packaging

- Batteries

- Light bulbs -Asbestos • Pathological

organisms • Insulated wire • Any material

that makes dark smoke otherthan vegetative materials For more information about the health effects of outdoor burning visit:

www.epa.gov/r10earth/FARR.htm 40 CFR 49.132 General Open Burning' Who to Contact 

# + for more Information: ConfederatedTribes ofthe Umatilla Indian Reservation (CTUIR) Office ofAir Quality 4641111rnine Way Pendleton, Oregon 97801 Phone: 541-429-7080 Fax: 541-429-7422 http://air.urnatilla.nsn.us 

# &EPA US EPA: 1-800-424-4EPA www.epa.gov/r10earth/FARR.htm Smoke impacts on public roads, schools, daycares, medical facilities, elder homes and other sensitive people or areas must be prevented as a condition ofthis permit. Buming is not permitted during burn bans or air pollution episodes, or when the CTUIR OAQ or EPA determines that burning will cause an adverse impact to air quality. This permit is part of a federal air quality program administered by the CTUIR OAQ to control emissions of air pollutants and manage smoke for air quality purposes. These rules apply to any person within the exterior boundaries ofthe Umatilla Indian Reservation. The public reporting andrecordkeeping burden forIhis collection ofinformalion is estimaled to average 0.10 hourperresponse. Send comments on lheAgency's need forIhis information. the accuracyofthe providedburden estimales. andanysuggested methods for minimizing respondentburden, including through the use ofautomatedcollection techniques to the Director. Collection Strategies Division. U.S. Environmental Protection Agency (28221). 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control numberin any correspondence. Do notsend the completed form to this address. Approved OMS 2060-055ll 

# V Approval Expiras 513112011**~** We appreciate your comments orfeedback. Please write below.

Q: Why do I needa permit? A: Smokefrom open burning is an air pollutant which affects air quality and public health (especially for children and the elderty). Q: What are some alternatives to outdoor burning? A: Chipping and shredding vegetation for composting. Also, household items such as glass, plastics and paper can be recycled and should not be burned. Contact CTUIR Tribal Environmental Restoration Facility (541-276-4040) for more information. Q: How can I burn more cleanly? A: Make sure your fuel is dry, separate the fire from damp ground, do not compact fuel and be sure there is enough draft to keep the fire burning hot. Q: Are there exceptions? A: Cultural, traditional and recreational fires are exempt and do not require a permit.**'1J~on** CDO)-O :::J**~:::!l::::l** 0.
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### 1:iOcn""' omForm Approved OMS 2060-0558 Approval Expires 5/31/2011 

# &

# EPA United States Environmental Protection Agency Federal Air Rules for Reservations Region 10, OAWT 107 1200 6thAve, Ste. 900 Seattle, WA 98101 Hotline: 800-424-4EPA Fax: 206-553-0110 www.epa.gov/r10earth/FARR.htm Nez Perce Tribe ERWM - Air Quality Program P. O. Box 365,109 Lolo Street Lapwai, 10 83540 Phone: 208-843-9381 800-720-4089 Fax: 208-843-7411 www.nezperce.org 

### NEZ PERCE RESERVATION AIR QUALITY PERMIT: AGRICULTURAL BURN INSTRUCTIONS, TERMS 

### & CONDITIONS Anas;riculturalburn is the burning a/ves;etative debris (rom an agrjculturalactivity thatjs necessary tor disease orpest control. ortor crop vropagation and/orcrop rotation. This includes conservation reserveprogram (CRP) fields. Forestry-related, smallandlarge open burns require a differentpermit. Firefighter trainings require a large open burnpermit. Permit applicants are responsible for following all instructions, terms andconditions regarding agricultural burning within the exterior boundaries of the 1863 Nez Perce Reservation. Aftersending in theAir QualityPermitApplication (pages 3-4) andreceiving approval to burn, THIS SIGNED SHEETIS YOUR PERMIT (pages 1-2). Keep itavailableand provide itupon request to theNez Perce Tribe or

# u.s. EPA inspectors. 40 CFR 49.133AgriculturalBurningPermits. Applicant Name Applicant Signature

INSTRUCTIONS Step 1. Complete permit application, pages 3-4. Step 2. Submit completed permit application to the Nez Perce Tribe (NPT) Air Quality Program at least one business day prior to the proposedbum date. Nez Perce ReservationAgricultural Burn Permits cost $Q perpermit. Fees must bepaid to the NPTAir Quality Program prior to burning. NOTE: Applicants leasing tribally-owned land must also fill out a NPTLand Services Program Burn Permit form, available at the NPT Land Services Office, 102 Agency Rd., Lapwai, 10, (208) 843-7392. Step 3. Call 208-843-9381 or 800-720-4089 to request to burn no later than 2:00 PM priorto the day of the desired burn. FromJuly-October. please contact the NPT Field Coordinator at 208-790-1154. Applicants should leave a message providing the following information: a. Name and phone number b. Field number(s) c. Date ofrequested bum d. Duration ofburn iflonger than one day e. Crop type and numberofacres/piles for each field f. Special considerations, ifany (canyon rim, nearhighway, near a town) NOTE: Callingby 2:00 PM does not guarantee a next dayburnapproval. Step 4. Ifapproved, applicants will receive a preliminary bum decision and ignition time by telephone by 7:00 PMprior to the day ofthe approvedbum. Ifnot approved to burn, applicants will not receive a call. Burn approvals will consider: a. The current and projected air quality conditions b. Proximityto sensitive areas (neartowns, schools, roads, canyons rims) c. The order ofbumrequests received from applicants ("first come, first served" basis) d. Applicant's record ofcompliance e. Otherrelevant factors Step 5. Ifthe preliminary burn decision changes due to poor air quality and/or updated forecast information, the NPTAir Quality Program will call applicant by9:00 AM the day ofthe burn.

EPA Form 7630-1 TillS 

## is \'OUR 

### PERMIT: ;\\;\ilable Burning pg 1of4FormApproved OMB 2060-0558 Approval Expires 5/31/2011 Step 6. Prior to ignition, the burner must speak with the NPTAir Quality Program/Field Coordinatorto receive final approval to burn. Step 7. As a condition ofthis permit, within 24 hours after the burn. you must contact the NPTAir Quality Program with yourpostburn report. You should provide the following information: a. Name b. Date ofthe burn c. Start and end times ofthe burn d. The size ofany remaining unburned material (ifthe burn was not completed) TERMSAND CONDITIONS 1. This permit is part ofa federal air quality program administeredby the Nez Perce Tribe to control emissions of airpollutants and manage smoke for air quality purposes. These rules apply to any person within the exterior boundaries ofthe 1863 Nez Perce Indian Reservation. 2. Smoke impacts on public roads, schools, daycares, medical facilities, elderhomes and other sensitive people or areas must be prevented as a condition ofthis permit. Applicants must have fiaggers stationed for burns that could potentially impact roadways. 3. Applicants must be reachable by phone or othermeans ofcommunication during the burn. Ifneeded, the NPT or EPA will notifY the applicant to discontinue lighting immediately. NOTE: The NPTAir Quality Program considers the following factors in the decision to shut downburning: a. Wind speed, direction, or sudden shifts b. Extended orhigh levels ofsmoke in the area c. Proximity ofsmoke to canyon rims, roadways, towns, houses, businesses, and sensitivepopulations d. Otherrelevant factors 4. Applicants are responsible for compliance with any applicable burn safety requirements and must also obtain applicable fire safety permits. Contact your local fire district or sheriff's office for fire safety permit information. 5. Agricultural Burning is not permitted during burn bans orairpollution episodes, orwhen the NPT orEPA determines that burning will cause an adverse impact to air quality. 6. The following materials are prohibited: Paper, paperproducts, orcardboardmore than necessary to start a fire unless it is produced at a single-family residence orresidential site with four or fewer housing units; garbage; dead animals or parts ofdead animals;junkedmotor vehicles or any materials resulting from a salvage operation; tires orrubber materials orproducts; plastics, plasticproducts, or styrofoam; asphalt orasphaltic material (roofing); tar, tarpaper, petroleum products, orpaints; lumber or timbers treated with preservatives; construction ordemolition waste; pesticides, herbicides, fertilizers, orother chemicals; insulated wire, batteries. orlight bulbs; mercury containing materials (thermometers, computers); asbestos or asbestos-containing materials; pathogenic or hazardous wastes; orany material that makes dark smoke ornoxious fumes other than vegetative materials. 7. Burning must be conducted in compliance with 40 CFR49.131 General Open Burning and 49.133 Agricultural Burning Permits. 8. Burning conducted without permission from the NPT ERWMAir Quality Program and/or failure to follow the FARR permit procedures, terms and conditions are violations ofthe FARR and the federal CleanAirAct and are subject to penalties up to $37.500 per day ofviolation.
The public reporting and recordkeeping burden for this collection of information is estimated to average 0.35 hour per response. Send comments on the Agency's need for this information, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden, including through the useof automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 PennsylvaniaAve., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address. EPA Form 7630-1 

### TIllS IS YOUR PERMIT: A\ailablc Wbile Burning pg 2 of4Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

# &

# EPA United States Environmental Protection Agency Federal Air Rules for Reservations Region 10, OAWT 107 1200 6th Ave, Ste. 900, Seattle, WA98101 Hotline: 800-424-4EPA, Fax: 206-553-0110 www.epa.gov/r10earth/FARR.htm 

# (i) Nez Perce Tribe

# ~~\ ERWM - Air Quality Prop,ram P.O. Box 365, 109 Lolo S reet, Lapwai, ID 83540

## ~"h-Of".$ Phone: 208-843-9381 80Q..72Q..4089**~** Fax: 208-843-7411 www.nezperce.org 

### NEZ PERCE RESERVATION AIR QUALITY PERMIT APPLICATION: AGRICULTURAL BURN Complete this application and submit it at least one business day prior to the proposed burn date. Submit completed permit application to: Nez Perce Tribe, ERWM • Air Quality Program, P.O, Box 365, 109 Lolo Street, Lapwai, Idaho 83540 Phone: 800·720-4089 or208·843·9381 Fax: 208·843·7411 Contact Information 1. Company Name 2. Date
3. Applicant Name 4. Primary Phone
5. Physical Address 6. Additional Phone
7. MailingAddress (if differentfrom above) 8. Fax
9. City, State, Zip Code 10. County of Burn
11. Person Conducting the Burn (if different from applicant) 12. Phone of Person Conducting the Burn (if different from applicant) Description of Field Locatlon(s) 13. Field Number 14.Township 15. Range 16. Section 17. Quarter Section 18. 19. Crop Type: County I Turf Grasses II Cereal Grain III Legumes IV CRP 

### V Other (Specify) 20. Special Features: A. Adjacent to timber B. Adjacent to highwayor major road C. Morning burn requested D. Special wind direction needed E. Contains or is next to steep slopes F. Borders on canyon rim G. Field has been baled 21. Number ofAcres or Piles (indicate type that applies) 22. Average Size of Each Pile: (Length x Width x Height in feet)Exampie: 1 35N 1W 7 NW, NE Nez Perce I B.C.D 4 piles 20ft

### x 20ft x 15ft

Forest Protective District(s) & Rural Fire District Information 23. Field Number (from above list) 24. Forest Protective District (list only one per box) 25.Rural Fire District (list only one per box) Example; 1, 2, 3 Craig Mountain Cottonwood Volunteer City/Rural

26. You will be issued a fire safety permit by the NPT Fire Management Program. Write in the fax number or address where it should be sent: EPA Form 7630-1 

### T HIrsy pg 30f4Form Approved OMS 2060-0558 Approval Expires 5/31/2011 Burn Information 27. Please locate and identify in the box below: Field(s) to be burned, access roads, highways, houses, businesses or other sensitive areas that could be impacted by the burning to be conducted. Indicate distance and direction. When more than one field is shown, label the field using the field number from page 3 of this application. Attach additional pages as needed to apply for multiple fields. A tract map, GPS map or other similar map may also be used.

28. Estimated duration of burn if longerthan one day:
29. Fire Safety Methods: Please indicate the measures you will take to prevent escaped burns and smoke danger: o water availability 0 hand tool availability 0 heavy equipment availability 0 fire breaks or safety zones o flaggers 0 other 0 other

____________ Applicants must also obtain applicable fire safety permits. Contact your local fire district or sheriff's office for fire safety permit information. 30. Remarks:

APPLICANT'S STATEMENT (To be signed by the applicant) 31. I certify that the information provided as part of this application is true and accurate to the best of my knowledge and that I have read, understand, and agree to abide by the permit's terms and conditions.**Name~~~** ___________ (signature) Name**(·~prZin~te~d-o~rt~yp~e~d)~---------** Oate

___
EPA Form 7630-1 

### THIS IS YOUR APPLICATfON: Return to the Nez Perce Tribe Air Quality Program pg 4 of 4Form A roved OMB 2060-0558 A roval Ex ires 5/31/2011 Permit Number: (To Be Assigned by CTUIR OAQ) United States Environmental Protection Agency (EPA) Confederated Tribes ofthe Umatilla Indian Reservation (CTUIR) Federal Air Rules for Reservations (FARR) Office ofAirQuality (OAQ) Region 10, OAWT 107**~** CTUIR-DOSE Office ofAir Quality 1200 6th Ave., Ste. 900 .­

# EA~ 46411 Timine Way Seattle, WA98101 • ., Pendleton, OR 97801 Hotline: 1-800-424-4EPA Phone: 541-429-7080 Fax: 206-553-0110 Fax: 541-429-7422 www.epa.gov/r10earth/FARR.htm http://air.umatilla.nsn.us 

### UMATILLA INDIAN RESERVATION OFFICE OF AIR QUALITY PERMIT: AGRICULTURAL BURN PERMIT INSTRUCTIONS, TERMS 

### & CONDITIONS 

# IAn agricultural bum is the buming ofvegetative debris from an agricultural activity that is necessary for disease

or pest control, orfor crop propagation and/or crop rotation. This includes Conservation Reserve Program (CRP)

. fields. Forestry-related, small and large open burns require a different permit. Firefighter trainings require a large 

# I open bum permit. Permit applicants are responsible for following all instructions, terms and conditions regarding

agricultural burning within the exterior boundaries ofthe Umatilla Indian Reservation. After sending in the Air Quality Agricultural Burn Permit Application (pages 3-4) and receiving approval to burn, KEEP THIS SIGNED SHEETAS YOLIR PERMIT (pages 1-2). Have it available and provide it upon request to the CTUIR Office ofAir Quality personnel or U.S. EPA inspectors. 40 CFR 49. 133AgriculturalBurning Permits Printed Applicant Name: General Terms and Conditions 1. Applicants must complete a permit application obtained from the CTUIR OAQ or online at http://air.umatilla.nsn.us orwww.epa.gov/r10earth/FARR.htm

. a. Applications must be submitted to the CTUIR OAQ via fax or received in the mail at least 3 business days priorto desired bum date. b. CTUIRAgricultural bum permits cost $0. c. Please apply early and ensure all documents are submitted to the OAQ prior to requesting permission to burn. 2. Applicants must request and receive burn approval from the CTUIR OAO Personnel at: 541-429-7080. 3. Ifa field is partially on and off the CTUIR Reservation, the applicant needs to apply to both the CTUIR OAO and Umatilla County Bum Permit Program (1-800-305-BURN) and must work with both agencies until the field 

### I buming process is completed with the post burn report.

4. Applicants must shut down burns when requested to do so by the CTUIR OAO or US EPA. CTUIR OAO and US EPA consider the following factors when deciding whether a burn should be shut down: a. Wind speed, direction, or sudden shifts b. Extended or extremely high levels of particulate matter in the atmosphere c. Fire safety and control d. Proximity to canyon rims, roadways, towns, houses, businesses, and other sensitive populations e. Other relevant factors 5. Applicants are responsible for conducting test burns if requested by CTUIR OAO or EPA. 6. Applicants must make all required calls to the CTUIR OAO as described in the instructions in this form. Applicants must follow all procedures specified in this form and are responsible for following all procedures and guidelines regarding agricultural burning on the Umatilla Indian Reservation. 7. Smoke impacts on public roads, schools, daycares, medical facilities, elder homes and other sensitive people or areas must be prevented as a condition ofthis permit. Applicants must have flaggers stationed for bums that could potentially impact roadways. 8. Burning must be conducted in compliance with 40 CFR 49.131 General Open Burning and 49.133 Agricultural Burning Permits. For a copy ofthese rules, please contact the CTUIR**~AO.** pg TUl IS YOl.!R PERMIT: K<:c1'Form Approved OMB 2060-0558 Approval Expires 513112011 9. Burning conducted without authorization ofthe CTUIR OAO and/or failure to follow the FARR permit procedures are violations ofthe federal Clean AirAct and the FARR and are subject to penalties up to $37,500 per day ofviolation. 10. Applicants are responsible for compliance with any/all applicable burn safety requirements and must obtain any/all fire safety permits. Contact the Umatilla Tribal Fire Department (541-429-7801) for fire safety and permit information. 

### Instructions for Obtaining Authorization to Burn Application Process 1. Obtain, fill out, and submit a permit application via fax or mail to the CTUIR OAO office. 2. Application will be reviewed for completeness and assigned a permit number, which will be included at the top ofthe permit section retained by applicant. 

### Procedures forthe Day Priorto the Requested Burn Day 1. Applicant will be placed on the pending burn list once the application is submitted to CTUIR OAO office and a permit number is issued by CTUIR**~AO.** 2. Applicant will be contacted by the CTUIR OAO staffwhen a preliminary burn day and burn time is determined. 3 The CTUIR OAO staffwill review requested fields to determine recommendation for preliminary burn decisions. Field burn priority will be as follows: a. Favorable conditions for sensitive areas (fields neartowns, roads, canyons) b. The preferred area to be burned (in terms offorecasted conditions) c. The order of burn requests received from the applicants 

### Procedures for the Burn Day 1. Applicants will be called by the CTUIR OAO by 9:00 AM to verify final burn decisions. 2. Applicants must be reachable by phone or other means ofcommunication during the day ofthe burn, should there be a change in the burn decision and it is necessary to cease all burning. NOTE: If applicants are not reachable and continue burning, they are in violation ofthis permit. 3. All fires must be ignited and must be completely out within approved burn duration times. 

### Post-Burn Procedures 1. As a condition ofthis permit, within 24 hours after completing the burn, the applicant must contact the CTUIR OAO with post-burn information and may leave a telephone message, email orfax with the following post-bum information: a. Name, as it is on application b. Date, time and durations ofthe bum(s) c. How the burn went and if it was completed d. Number ofacres actually burned e. The size ofany remaining unburned material (if bum was not completed) NOTE: If an applicant does not submitthe post-burn information, then the applicant will be out ofcompliance with permit conditions, and subject to enforcement action. 

### Applicant's Signature I certify that I have read. understand and have followed the instructions on this form and agree to abide by the permit's instructions, terms and conditions.
ApplicantSSignature is required forpermit to be valid. Date The public reporting and recordkeeping burden for this collection of information is estimated to average 0.35 hour per response. Send comments on the Agency's need for this information, the accuracy ofthe 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 ProtectionAgency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. 

### Do not send the completed form tothis address. EPA Form 7630-10 

### TlHS IS YOUR PERi\lIT: K, !\\ail;lble 

### While Burnin!l. pg2of4Form Approved OMB 2060-0558 Approval Expires 5/31/2011 ForIntemal Use Only Permit Number: Date: Initials of CTUIR Staff: United States Environmental Protection Agency (EPA) Confederated Tribes ofthe Umatilla Indian Reservation Federal Air Rules for Reservations (FARR) Office ofAir Quality (OAQ) Region 10, OAWT 107 

# &EPA CTUIR-DOSE 1200 6th Ave., Ste. 900 Office ofAir Quality Seattle, WA 98101 46411 Timine Way Hotline: 1-800-424-4EPA Pendleton, OR 97801 Phone: 541-429·7080 Fax: 206-553-0110 Fax: 541-429-7422 www.epa.gov/r10earth/FARR.htm http://air.umatilla.nsn.us 

### UMATILLA INDIAN RESERVATION OFFICE OF AIR QUALITY PERMIT: AGRICULTURAL BURN PERMIT APPLICATION Complete this application and submit it at least three business days prior to the proposed burn date. Submit completed forms to: CTUIR-DOSE, Office ofAir Quality, 46411 Timine Way, Pendleton, Oregon 97801. Phone: 541-429-7080, Fax: 541-429-7422. Contact Information 1 . Company Name 2. Date
3. Applicant Name 4. Primary Phone
5. Physical Address 6. Additional Phone
7. Mailing Address (if different from above) 8. Fax and Email
9. City, State, Zip Code 10. County of Burn
11. Name of Person Conducting Burn (if different from applicant) 12. Phone of Person Conducting Burn (if different from applicant) Description of Field Location 13. 14. 15. 16. 17. 18. 19. 20. Special Features: 21. Field Township Range Sec- Quarter County Crop Type: A. Adjacent to timber Number Number tion Section I Turf Grasses B. Adjacent to highway or major road ofAcresD II Cereal Grain C. Morning burn requested or Piles D III Field and D. Special wind direction needed (check box

Forage Grasses E. Contains or is next to steep slopes that IV Legumes F. Borders on canyon rim. applies) V Other (Specify) Example: 35N 1W 7 Uma­ / B.C.D 100 1 tilla

22. Total Acres: EPA Form 7630-10 I HIS IS YOUR ,\PPLlCArlON: 

### i<l:turn to thv 

### CrUff{ (lAC) pg 3 of 4Form Approved 

### oMB 2060-0558 Approval Expires 5/31/2011 Burn Information 23. Land Ownership (Check appropriate box). 

### o Trust Land 

### o Fee Land Agriculture burn permits on Trust Land also require Bureau of Indian Affairs, Umatilla Agency, approvals. Authorizing Signatures: Superintendant, Bureau ofIndian Affairs, Umatilla Agency Date
Natural Respurce Management Team, Bureau ofIndianAffairs, Umatilla Agency Date 24. Map: Attach a printout or draw a map ofthe locations listed on this application to be burned, which shows local access roads, highways, residences, businesses or other areas that have potential to be impacted by the burning to be conducted. Indicate distance and direction. If more than one field is shown, please identify the fields as you did on the front ofthis application. Attach additional pages as needed to apply for multiple fields. A tract map, GPS map or other similar map may also be used.

25. Burning Methods: Describe the burning method(s) to be used: Method: 

### o Propane Torch 

### o Other 26. Fire Safety Methods: Please indicate the measures you will take to prevent escaped burns and smoke danger: 

### o Water Truck 

### o Hand Tools 

### o Heavy Equipment 

### o Fire Breaks and Safety Zones 0 Flaggers Other pertinent information: APPLICANT'S STATEMENT (To be signed by the applicant): I certify that the information provided as part ofthis application is true and accurate to the best of my knowledge and that I have read, understand and agree to abide by the permit's terms and conditions.

Signature of Applicant PrintedApplicant Name Date For Internal Use Only Approved by: loate:

, ' ,- -, EPA Form 7630-10 pg 4 of4 

## r**1!I~)** 

### IS 'r

### (JU R !\PPU('j\"

### IlON: Return (0 

### the (' IUJ R O!\OForm Approved OMS 2060-0558 Approval Expires 5/31/2011 

# oEPA United States Environmental Protection Agency Federal Air Rules for Reservations Region 10, OAWT 107 1200 6thAve, Ste. 900 Seattle, WA98101 Hotline: 800-424-4EPA Fax: 206-553-0110 www.epa.govlr10earth/FARR.htm Nez Perce Tribe ERWM - Air Quality Program P.O. Box 365, 109 Lolo Street Lapwai, 10 83540 Phone: 800-720-4089 208-843-9381 Fax: 208-843-7411 www.nezperce.org 

### NEZ PERCE RESERVATION AIR QUALITY PERMIT: FORESTRY BURN INSTRUCTIONS, TERMS & CONDITIONS Aforestry burn is the burning o(vegetative debris from aforestry orsilviculturalactivity that is necessary tor disease or pest control. reduction of/irehazard. reforestation orecosystem management.Agricultural. smallandlarge open burns require a differentpermit. Firifighter trainings require a large open burnpermit. Permitapplicants are responsible for following all instructions, terms andconditions regardingforestry burning within the exterior boundaries of the 1863 Nez PerceReservation. Aftersending in theAir QualityPermitApplication (pages 3-4) andreceivingapproval to burn. THIS SIGNED SHEET IS YOUR PERMIT (pages 1-2). Keep it available andprovide itupon request to the Nez Perce Tribe or

# u.s. EPA inspectors. 40 CFR 49.134 Forestry andSilviculturalBurningPermits Applicant Name Applicant Signature

INSTRUCTIONS Step 1. Complete pennit application, pages 3-4. Step 2. Submit completed pennit application to the Nez Perce Tribe (NPT)Air Quality Program at least one business day prior to the proposed bum date. Nez Perce Reservation Forestry Bum Pennits cost $Jlperpennit. Fees must be paid to the NPTAir Quality Program prior to burning. Step3. Call 208-843-9381 or 800-720-4089 to request to bum no laterthan 2:00 PMprior to the day ofthe desired bum. Applicants should leave a message providing the following infonnation: a. Name and phone number b. Burn name(s) ornumber(s) c. Date ofrequested bum d. Duration ofbum iflongerthan one day e. Type and size ofbum (Forestry bum & numberofacres orpiles) f. Special considerations, ifany (canyon rim, nearhighway, neara town) NOTE: Calling by 2:00 PM does not guarantee a next day bum approval. Step4. Ifapproved, applicants will receive a preliminary bum decision and ignition time by telephone by 4:30 PM priorto the day ofthe approved bum. Ifnot approved to bum, applicants will not receive a call. Bum approvals will consider: a. The current and projected air quality conditions b. Proximity to sensitive areas (near towns, schools, roads, canyons rims) c. The order ofbum requests received from applicants ("first come, first served" basis) d. Applicant's record ofcompliance e. Other relevant factors Step 5. Ifthe preliminary bum decision changes due to poor airquality and/or updated forecast infonnation, the NPTAir Quality Program will call applicant by 9:00AM the day ofthe bum. Step 6. As a condition ofthis pennit, within 24 hours after the bum. you must contact the NPTAir Quality Program with your postbum report. You should provide the following infonnation: a. Name b. Date ofthe bum c. Start and end times ofthe bum d. The size ofany remainingunburned material (ifthe bum was not completed) pg 1 of4 EPA Form 7630-2 

### TllfS IS YOUR PFRMn: K IeForm Approved OMB 2060-0558 Approval Expires 5/31/2011 TERMSAND CONDITIONS I. This pennit is part ofa federal air quality program administered by the Nez Perce Tribe to control emissions ofair pollutants and manage smoke for air quality purposes. These rules apply to anyperson within the exteriorboundaries of the 1863 Nez Perce Indian Reservation. 2. Smoke impacts on public roads, schools, daycares, medical facilities, elder homes and other sensitive people orareas must be prevented as a condition ofthis pennit. Applicants must have flaggers stationed for burns that could potentially impact roadways. 3. Applicants must be reachable byphone orother means ofcommunication during the burn. Ifneeded, the NPT orEPA will notify the applicant to discontinue lighting immediately. NOTE: The NPTAir Quality Program considers the following factors in the decision to shut down burning: a. Wind speed, direction, or sudden shifts b. Extended orhigh levels ofsmoke in the area c. Proximity ofsmoke to canyon rims, roadways, towns, houses, businesses, and sensitive populations d. Otherrelevant factors 4. Applicants are responsible for compliance with any applicable burn safety requirements and must also obtain applicable fire safety pennits. Contactyour local fire district or sheriff's office for fire safety pennit infonnation. 5. Forestry Burning is not pennitted during bum bans orairpollution episodes, orwhen the NPTorEPA detennines that burning will cause an adverse impact to air quality. 6. The following materials are prohibited: Paper, paperproduets, or cardboard more than necessary to start a fire it is produced at a single-family residence or residential site with four orfewer housing units; garbage; dead animals orparts ofdead animals;junked motor vehicles or any materials resulting from a salvage operation; tires orrubber materials orproducts; plastics, plastic products, or styrofoam; asphalt orasphaltic material (roofing); tar, tarpaper, petroleum products, orpaints; lumber ortimbers treated with preservatives; construction or demolition waste; pesticides, herbicides, fertilizers, orother chemicals; insulatedwire, batteries, or light bulbs; mercury containing materials (thernl0meters, computers); asbestos Of asbestos-eontaining materials; pathogenic orhazardous wastes; or any material that makes dark smoke ornoxious fumes otherthan vegetative materials. 7. Burning must be eonducted in compliance with 40 CFR49.131 General Open Burning and49.134 Forestry and Silvicultural BurningPennits. 8. Burning conducted without pennission from the NPT ERWM Air Quality Program and/or failure to follow the FARR pennitprocedures, tenns and conditions are violations oftheFARR and the federal Clean AirAct and are subject to penalties up to $37,500 perday ofviolation.

The public reporting and recordkeeping burden for this collection of information is estimated to average one hour per response. Send comments on the Agency's need for this information, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden. including through the use ofautomated 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 7630-2 pg 2 of4 

### THIS IS YOUR PFR\lIT: Keep .'\v:uJahk While B IrnillgForm Approved OMB 2060-0558 Approval Expires 5/31/2011 

# &

# EPA United States Environmental Protection Agency Nez Perce Tribe 

# (i) ERWM - Air Quality Program Federal Air Rules for Reservations

# ~~~ P.O. Box 365, 109 Lolo Street, Region 10, OAWT 107 Lapwai, 1083540 1200 6th Ave, Ste. 900, Seattle, WA 98101

### ~of Df..
... $ Phone: 208-843-9381 Hotline: 800-424-4EPA, Fax: 206-553-0110 800-720-4089 rvo Fax: 208-843-7411 www.epa.gov/r10earth/FARR.htm**~** www.nezperce.org 

### NEZ PERCE RESERVATION AIR QUALITY PERMIT APPLICATION: FORESTRY BURN Complete this application and submit it at least one business day prior to the proposed burn date. Submit completed permit application to: Nez Perce Tribe, ERWM • Air Quality Program, P.O. Box 365,109 Lolo Street, Lapwai, Idaho 83540 Phone: 800·720-4089 or 208·843·9381 Fax: 208·843·7411 Contact Information 1. Company Name 2. Date
3. Applicant Name 4. Primary Phone
5. Physical Address 6. Additional Phone
7. Mailing Address (if different from above) 8. Fax
9. City, State, Zip Code 10. County of Burn
11. Person Conducting the Burn (if different from applicant) 12. Phone of Person Conducting the Burn (if different from applicant) Description of Burn Location(s): You may attach an approved burn plan. Ifone is available, please reference the page numbers where the requested information can be located. 13. 14. 15. 16. 17. 18. Fuel Typel 19. Fuel Size: 20. 21. 22. Burn Township Range Section County Method: A. 0 to 3 inches in Number Average Elevation Number I Hand Pile diameter ofAcres Size of Each (in feet) II Machine Pile B. 3 inches or larger or Piles Pile:

a. Skidder/Dozer in diameter (indicate (Length b. Excavator type that x Width x III Broadcast Bum If bothA& B applies) Height in IV Windrow Bum apply, estimate % feet) V Other (Specify) of each Example:
. 35N 1W 7 Nez /fa A= 70% 10piles 20ftx 20ft 4,300 ft 1 Perce 8=30% x 15ft

EPA Form 7630-2 

### TillS IS 'VOL! R**f\PPL!C,\TIO~.J:** 

### Return til 

### 1h(' '(7 

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### OuaJity Program pg 3 of 4Form Approved OMS 2060-0558 Approval Expires 5/31/2011 Burn Information 23. Please locate and identify in the box below: Burn location(s), access roads, highways, houses, businesses or other sensitive areas that could be impacted by the burning to be conducted. Indicate distance and direction. When more than one burn is shown, label the burn using the burn number from page 3 of this application. Attach additional pages as needed to apply for multiple burns. A tract map, GPS map or other similar map may also be used.

24. Estimated duration of burn if longer than one day: 25. Fire Safety Methods: Please indicate the measures you will take to prevent escaped burns and smoke danger: 

### o water availability 0 hand tool availability 0 heavy equipment availability 0 fire breaks or safety zones 

## o flaggers 0 other 0 other

____________ Applicants must also obtain applicable fire safety permits. Contact your local fire district or sheriff's office for fire safety permit information. 26. Remarks:

APPLICANT'S STATEMENT (To be signed by the applicant) 27. I certify that the information provided as part ofthis application is true and accurate to the best of my knowledge and that I have read, understand, and agree to abide by the permit's terms and conditions. Name Name Date**'-(sZig=na~tu~r~e)~------------ (~p7rin~re~d~o~r~ty-pe"d~)----------**  ------­ EPA Form 7630-2 pg 4 of 4 

### THIS IS 'YUUR ,\PPLlCYIlON: RC1lJrn to tIll: Nez Perce Tribe Air Quality ProgramFormA roved OMB 2060-0558 A roval Ex ires 5/31/2011 Pennlt Number: (To Be Assigned by CTUIR OAQ) Confederated Tribes ofthe Umatilla Indian Reservation United States Environmental ProtectionAgency (EPA) Federal Air Rules for Reservations (FARR) Office ofAir Quality (OAQ) Region 10, OAWT 107**~** CTUIR-DOSE Office ofAir Quality 12006thAve.,Ste.900 -­

# EA~ 46411 Timine Way Seattle, WA 98101 • ., Pendleton, OR 97801 Hotline: 1-800-424-4EPA Phone: 541429·7080 Fax: 206-553-0110 Fax: 541-429-7422 

### I www.epa.gov/r10earth/FARRhtm http://air.umatilla.nsn.us 

### UMATILLA INDIAN RESERVATION OFFICE OF AIR QUALITY PERMIT: FORESTRY BURN PERMIT INSTRUCTIONS, TERMS 

### & CONDITIONS A forestry burn is the burning ofvegetative debris from a forestry or silvicultural activity that is necessary for disease or pest control, reduction offire hazard, reforestation or ecosystem management. Agricultural, small and large open burns require a different permit. Firefighter trainings require a large open burn permit. Permit applicants are responsible for following all instructions, terms and conditions regarding forestry burning within the exterior boundaries ofthe Umatilla Indian Reservation. After sending in the Air Quality Forestry Burn Permit Application (pages 3-4) and receiving approval to burn, KEEP THIS SIGNED SHEET AS YOUR PERMIT (pages 1-2). Have it available and provide it upon request to the CTUIR Office ofAir Quality personnel or U.S. EPA inspectors. 40 CFR 49. 134 Forestry and Silvicultural Burning Permits Printed Applicant Name: General Terms and Conditions 1. Applicants must complete a permit application obtained from the CTUIR OAQ or online at http://air.umatilla.nsn.us or www.epa.gov/r10earth/FARR.htm. a. Applications must be submitted to the CTUIR OAQ via fax or received in the mail at least 3 business days priorto desired burn date. b. CTUIR Forestry burn permits cost $0. c. Please apply early and ensure all documents are submitted to the OAQ prior to requesting permission to burn. 2. Applicants must request and receive burn approval from the CTUIR OAQ Personnel at: 541-429-7080.
3. Applicants must shut down burns when requested to do so by the CTUIR OAQ or US EPA. CTUIR OAQ and US EPA consider the following factors when deciding whether a burn should be shut down: a. Wind speed, direction, or sudden shifts b. Extended or extremely high levels ofparticulate matter in the atmosphere c. Fire safety and control d. Proximity to canyon rims, roadways, towns, houses, businesses, and other sensitive populations e. Other relevant factors 4. Applicants are responsible for conducting test burns if requested by the CTUIR OAQ or EPA. 5. Applicants must make all required calls to the CTUIR OAQ as described in the instructions in this form. Applicants must follow all procedures specified in this form and are responsible for following all procedures and guidelines regarding forestry burning on the Umatilla Indian Reservation, including the CTUIR OAQ's Best Forestry Bum Practices Guidelines (Appendix K ofthe Outdoor Burning Management Plan and Procedures) available through the CTUIR OAQ. 6. Smoke impacts on public roads, schools, daycares, medical facilities, elder homes and other sensitive people or areas must be prevented as a condition ofthis permit. Applicants must have flaggers stationed for burns that could potentially impact roadways. 7. Burning must be conducted in compliance with 40 CFR 49.131 General Open Burning and 49.134 Forestry and Silvicultural Burning Permits. For a copy ofthese rules, please contact the CTUIR OAQ.

pg of4 

### PLRMIT: Kc:.:pForm Approved OMB 2060-0558 Approval Expires 5/31/2011 8. Burning conducted without authorization ofthe CTUIR OAQ and/or failure to follow the FARR permit procedures are violations ofthe federal Clean AirAct and the FARR and are subject to penalties up to $37,500 per day ofviolation. 9. Applicants are responsible for compliance with any/all applicable burn safety requirements and must obtain any/all fire safety permits. Contact the Oregon Department of Forestry (541-276-3491) for fire safety and permit information. Instructions for Obtaining Authorization to Burn Application Process 1. Obtain, fill out, and submit a permit application via fax or mail to the CTUIR OAQ office. 2. Application will be reviewed for completeness and assigned a permit number, which will be included at the top ofthe permit section retained by applicant. Procedures for the Day Prior to the Requested Burn Day 1. Applicant will be placed on the pending burn list once the application is submitted to CTUIR OAQ office and a permit number is issued by CTUIR OAQ. 2. Applicant will be contacted by the CTUIR OAQ staff when a preliminary burn day and burn time is determined. 3 The CTUIR OAQ staff will review requested burns to determine recommendation for preliminary burn decisions. Burn priority will be as follows: a. Favorable conditions for sensitive areas (burns near towns, roads, canyons) b. The preferred area to be burned (in terms offorecasted conditions) c. The order of burn requests received from the applicants Procedures for the Burn Day 1. Applicants will be called by the CTUIR OAQ by 9:00 AM to verify final burn decisions. 2. Applicants must be reachable by phone or other means of communication during the day ofthe burn, should there be a change in the burn decision and it is necessary to cease all burning. NOTE: Ifapplicants are not reachable and continue burning, they are in violation ofthis permit. 3. All fires must be ignited and must be completely out within approved burn duration times. Post-Burn Procedures 1. As a condition ofthis permit, within 24 hours after completing the burn, the applicant must contact the CTUIR OAQ with post-burn information and may leave a telephone message, email or fax with the following post-burn information: a. Name, as it is on application b. Date, time and durations ofthe burn(s) c. How the burn went and if it was completed d. Number ofacres or amount actually burned e. The size of any remaining unburned material (if burn was not completed) NOTE: If an applicant does not submit the post-burn information, then the applicant will be out of compliance with permit conditions, and subject to enforcement action. Applicant's Signature I certify that I have read, understand and have followed the instructions on this form and agree to abide by the permit's instructions, terms and conditions.
Applicant

## sSignature is required forpermit to be valid. Date The public reporting and recordkeeping burden for this collection of information is estimated to average 0.35 hour per response. Send comments on the Agency's need for this information, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use ofautomated 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 7630-11 pg 2 of4Form Approved OMS 2060·0558 Approval Expires 5/31/2011 ForIntemal Use Only Permit Number: Date: Initials ofCTUIR Staff: Confederated Tribes ofthe Umatilla Indian Reservation (CTUIR) Federal Air Rules for Reservations (FARR) United States Environmental ProtectionAgency (EPA) Office ofAir Quality (OAQ) Region 10, OAWT 107**~** CTUIR·DOSE Office ofAir Quality 12006thAve.,Ste.900 ••

## EA~ 46411 Timine Way Seattle, WA 981 01 • ., Pendleton, OR 97801 Hotline: 1·800·424-4EPA Phone: 541-429·7080 Fax: 206·553-0110 Fax: 541-429·7422 www.epa.gov/r10earth/FARR.htm hit ://air.umatilla.nsn.us 

### UMATILLA INDIAN RESERVATION OFFICE OF AIR QUALITY PERMIT: FORESTRY BURN PERMITAPPLICATION Complete this application and submit it at least three business days prior to the proposed burn date. Submit completed forms to: CTUIR-DOSE, Office ofAir Quality, 46411 Timine Way, Pendleton, Oregon 97801. Phone: 541-429-7080, Fax: 541-429-7422. Contact Information 1. Company Name 2. Date
3. Applicant Name 4. Primary Phone

5. Physical Address 6. Additional Phone

7. Mailing Address (if different from above) 8. Fax and Email
9. City, State, Zip Code 10. County of Burn

11. Name of Person Conducting Burn (if different from applicant) 12. Phone of Person Conducting Burn (if different from applicant) Proposed Burn: You may attach an approved burn plan. If one is available, please reference the page numbers where the requested information can be located. 13. Purpose ofthe Burn:

14. Requested Burn Date:

15. Fuel Conditions:

16. Burn Location:

20. Quartersection: 19. Section: 17. Township: 18. Range:

pg 30f4 EPA Form 7630·11 THIS IS '{OUR APPLlCArI(Form Approved OMB 2060-0558 Approval Expires 5/31/2011 Burn Information 21. Map: Attach a printout or draw a map ofthe locations listed on this application to be burned, which shows local access roads, highways, residences, businesses or other areas that have potential to be impacted by the burning to be conducted. Indicate distance and direction. A tract map, GPS map or other similar map may also be used.

22. Fuel Type and size of burn ' Pile dimensions 

### x width 

### x numher !1llmiJorof or

23. Burning Methods: Describe the burning method(s) to be used: Method: 

### o Propane Torch 

### o Other Pattern: 

### o Strip Burn 

### o Circle Burn 

### o Other 24, Estimated duration offlaming stage?
25. Estimated duration of smoldering stage? 26. Fire Safety Methods: Please indicate the measures you will take to prevent escaped burns and smoke danger: 

### o water availability 

### o hand tool availability 

### o heavy equipment availability 

### o fire breaks or safety zones 

### o flaggers 

### o other 

### o other Applicants must also obtain applicable fire safety permits. 27. Indicate the Safety Measures or Safety Routes:

28. Remarks: APPLICANT'S STATEMENT (To be signed by the applicant): I certify that the information provided as part ofthis application is true and accurate to the best of my knowledge and that I have read, understand and agree to abide by the permit's terms and conditions.

Signature of Applicant PrintedApplicant Name Date ForInternal Use Only Approved by: 

# I Date: EPA Form 7630-11 pg 4of4 THIS ISYOUR APPLICATION: Ih'mrl1 to 

### the CTU1R 

### OAr )FARRRegistration Instructions October 5, 2005 

# Instructions for Completing FARR Registration and Reporting Fornls
INITIAL/ANNUAL SOURCE REGISTRATION (EPA Form 7630-4) The Initial/Annual Source Registration Form collects basic information about your air pollution source, including such information as the names and mailing addresses ofthe owner and/or operator, the location ofthe source, the type ofbusiness, identification of air pollution emitting equipment and air pollution control devices, and the type and quantity ofairpollutants actually emitted to the environment. The owner or operator ofan airpollution source that existed on June 7, 2005 must submit an initial registration form to EPAbetween January 1 and February 15,2007. The owner or operator ofa new airpollution source that begins operation after June 7, 2005, must register the source with EPA within 90 days after beginning operation. After initial registration, the owner or operator ofan airpollution source must re-register the source each year during the January 1to February 15 registration period. Registrations must be submitted on the EPA forms. Copies ofthe registration forms may be obtained online at EPA Region 10's web site orby calling EPA at the number listed below. The EPA Region 10 "FARR" website www.cpa.gov/rlOc<1rth/FARR.htmis available for additional information and contains links to other helpful websites, including the EPA Region 10 Registration Web Page. At this web page you will find sample calculations for determining your source's potential to emit and for calculating actual and estimated emissions. In addition, there are links to specific sites to assist you in completing the registration forms. Assistance can also be obtained by calling the "FARR" hotline, 1-800-424-4372 and asking for help with "FARR" registration forms. Complete Section A, provide the information requested in Section B, complete the Table in Section C, and complete and sign Section D. Mail the completed form and attachments to the address listed at the end ofSection D.
A. GENERAL INFORMATION In this sectionyou will provide information about the location ofyour air pollution source, the type ofbusiness that is conducted there, the owner and operator ofyour source and the contact information for certain people responsible for the operation ofthe source and compliance with airpollution requirements. The Source (Facility) Name is the name on your State or local business license, the name that you list yourbusiness under in the telephone book, orthe name that you show on the sign posted on your source.FARR Registration Instructions October 5, 2005 

### The 

### Air Quality Operating Permit Number will be the numberonyour EPA-issued Part 71 operating permit oryour Part 49 Non-Title V operating permit ifyou have such a permit. Ifyou don'thave an EPA-issued operating permit, then leave the line blank ormark it as not applicable. The 

### Nature ofthe Business is the type ofbusiness that is conducted at your airpollution source. This shouldbe the same as you show on your federal income tax return 

### or on your State or local business license. You may also use your Standard Industrial Classification (SIC) Code ifyou know it. Include the 

### Telephone number, 

### Facsimile number, and street 

### Address ofyour airpollution source. This is the information that anyone woulduse to contact yourbusiness oruse to visit your source. Include the name ofthe 

### Indian Reservation within which your air pollution source is located. The 

### Compliance Contact is the local person that EPAcan talk to about air pollution requirements that apply to your source, including this requirement for Initiall Annual Source Registration. This person canbe the owner

### or operator, or an employee who is responsible for compliance with environmental or other governmental requirements, provided thatperson actually works at the location ofthe airpollution source. Forthe Compliance Contact, provide telephone and facsimile numbers, mailing address, and email address (ifapplicable). The 

### Owner is the person or corporation that owns the business which operates the airpollution source. Essentially, this is the person orcompanythat makes a profit from the business andwho pays federal income tax on the proceeds from the business. Provide the name ofthe owner (individual orcorporation), telephone and facsimile numbers, mailing address, and email address (ifapplicable). In addition, provide the name and title ofa 

### Contact person who is authorized to receive requests for data and information aboutthe air pollution source. Provide the telephone and facsimile numbers, mailing address and email address (ifapplicable) for this individual. The 

### Operator is the person orcorporation who is responsible for the day-to-day operation ofthe air pollution source. Ifthe Owner is also the Operator ofthe source, then leave this sectionblank or mark it as not applicable. Ifthe Ownerhas arranged for some other person or companyto operate the air pollution source, then complete this section. The Operator may be a contractor or a sub-division ofthe parentcompany (owner). Provide the name ofthe operator (individual or corporation), telephone and facsimile numbers, mailing address, and email address (if applicable). In addition, provide the name and title ofa 

### Contact person who is authorized to receive requests for data and information about the air pollution source. Provide the telephone and facsimile numbers, mailing address and email address (ifapplicable) for this individual.

2FARRRegistration Instructions October 5, 2005 

### The following is a sample ofhow to complete this portion ofthe Registration form. Identifying Information Source (Facility) Name 

### John's Auto Body Shop Air Quality Operating Permit No. (ifapplicable)---,N......:.:.../ A'"""'"-

__________ 

### Nature ofthe Business 

### Auto body repair and refinishing 

## SIC Code 7532 Telephone ( 

### 509 ) 555 - 1212 Facsimile ( 

### 509 ) 555 - 1000 Source Physical Address: Street 

### 101 Front Street City 

### Toppenish County 

### Yakima State 

### WA ZIP 

### 98948 Indian ReservationName 

### Yakama Reservation Compliance Contact _--:.J..;:.o",-"h:..!.n-=S:..:..:mc:.,:.i..:...;th-'--

____

### Title 

### Owner Telephone ( 

### 509) 555 - 1212 Ext. 

### 100 Facsimile ( 

### 509 ) 555 - 1000 Contact Person Mailing Address: Street (or PO Box #) _..;;;.1;.;:;0..;;;.1
..... F
..... r..;:.o"'-"nt.;....;::.S;..:.t..:...re.;:;;.;e;:;.t:...-

___ 

### City 

### Toppenish County 

### Yakima State 

### WA
_ZIP 

### 98948 ­ e.mail address 

### john@johnsautobodyshop.com

3

### --------------



# ----------------

------------

---



### -------------- F

ARR Registration Instructions October 5, 2005



### Owner's Name 

### John Smith Title 

### Owner Telephone ( 

### 509) 555 - 1212 Ext. 

### 100 Facsimile ( 

### 509 ) 555 - 1000 Owner's Mailing Address: Street (or PO Box#)**_-=l~O.:.l..:..F..:..r.:.on:...:..t:-=S..:..:tr,-=e:.:e:...:..t**

### ___ City

__**~;..,;:;o**

### .. p",,"pe=n=is=h,,---
__County 

### Yakima State 

## WA ZIP 

### 98948 ­ e.mail address 

### john@ johnsautobodyshop.com Contact

___**J~o::::.ih:...:.:n~S:..wm..:..:.it ..:..:h~** 

### ___Title'

__**..;:::O:..:.w~n.:.:e::.:..r**

### ___ (Person authorized to receive requests for data and information) 

### Telephone ( 

### 509 ) 555 - 1212 Ext. 

### 100 Facsimile ( 

### 509 ) 555 -1000 Contact Person Mailing Address: Street (or PO Box#) 

### 101 Front Street City

__**~..:....:o::..j:p+p=en:...:..:i=sh~**

### __ County 

### Yakima State 

## WA ZIP 

### 98948 ­ e.mail address 

### john@johnsautobodyshop.com Operator's Name

__

### -=S:..::a::..:mc:..;e::,...=as=-:::O:;..,:w..:..:n""'e""r

____(Ifdifferent from Owner). Telephone (,-_-,)
_______Ext.
___Facsimile '--_-'

_______ Operator'sMailing Address: Street (orPO Box #)

_____________

_________County
_______ State

___ ZIP

___ e.mail address Contact (Person authorizedto receive requests for data and information) 

### Telephone (,-_-,)
_______Ext.
___Facsimile '-_-'

______ Contact Person Mailing Address: Street (or PO Box #)

_________County
_______State ZIP e.mail address

4FARRRegistration Instructions October 5, 2005 

### B. ATTACHMENTS In this section, you will provide more detailed information about the operation ofyour air pollution source. This information will enable you and EPA to determine the type and quantity ofair pollutants thatyou emit to the environment. It

### will also enable you and EPA to determine what other air pollution requirements might apply to your source. Include all ofthefollowing information as attachments to this form: [J 

### Process flow chartidentifying all processing, combustion, handling, storage, and emission control equipment This is a graphical representation ofthe flow ofraw materials, fuels, and intermediary and final products for your source. This process flow chart can be hand drawn orcomputer generated. However, you must clearly label all steps in yourprocess and identify the processing equipment, combustion sources, material handling operations, and raw material and product storage facilities. You must also identify which equipment orprocessesproduce airpollutants that are released into the environment and identify any air pollution control equipment being used. Air pollutant releases can be direct, such as through a stack orchimney, orindirect such as through building ventilation systems or even windows and doors. [J 

### Narrative description ofthe production processes and air pollution control equipment This is a written description ofyour operation that supplements and explains the process flow chart. The narrative description must cover all ofthe processes, equipment, sources, operations, and facilities shown on the flow chart. [J 

### List ofall air pollutant generating equipment and activities; include model and serial numbers for portable equipment This is a list ofthe equipment and activities that generate airpollutants that are released to the environment. The list must include sufficient information about each ofpieces ofequipment (make, model, size, etc.) and activities (type ofactivity, location within the source, etc.) to enable EPAto identify them ifwe inspect the source. Forportable equipment that is used at multiple locations, include both the model and serial numbers ofthe equipment. Portable equipment does not include mobile sources, such as cars, trucks, tractors, orforklifts, or other equipment with internal combustion engines such as lawnmowers orweedwackers, etc. [J 

### Plot Plan This is a graphical representation ofyour entire facility, including the property upon which it is located and the nearby properties. This plotplan can be hand drawn or computer generated. However, it must clearly show: • The location ofall airpollution generating equipment and activities; • The property lines for the air pollution source; • The elevation above grade for each emission release point; and • The distance and direction to nearest residential orcommercial property. [J 

### Type and quantity offuels, including sulfur content offuels, used on a daily, annual and maximum hourly basis Iffuels are burned in your manufacturing or industrial process, then provide a written description ofthe type and quantity offuels used. This description must include the types offuels used, the 5FARR Registration Instructions October 5, 2005 

### sulfur content offuels ifpetroleum-based fuels are used or ifthe fuels are produced on site, and the amount offuel typically uscd in a day and in a year. You must also include the maximum amount offuel that you could use in an hour when operating at your maximum capacity. You do not need to provide information on fuels used in mobilc sources, such as cars, trucks, tractors, or fork lifts or other equipment with internal combustion engines such as lawnmowers, weedwackers, etc. Also, you do not need to provide information on fuels used strictly for space heating ifyour furnace orboiler is rated at 400,000 British thermal units (Btu) per hour or less. D Type and quantity ofraw materials used or final product produced on a daily, annual and maximum hourly basis This is a written description ofthe type and quantity ofraw materials typically used in a day and in a year. Alternatively, you can provide a description ofthe type and quantity ofthe final product typically produced in a day and in a year. The choice ofwhich ofthese to provide will depend upon the approach used to calculate your actual emissions ofair pollutants (see Section 2 Table ofAnnual Emissions,below). You must also provide information on the maximum amount ofraw material you could use in an hour, orthe maximum amount offinal product you couldproduce in an hour, when operating at maximum capacity (that is, the maximum rated capacity ofyour source). D Typical operating schedule, including number ofhours per day, number ofdays perweek and number ofweeks per year This is a written description ofthe typical operating schedule for your airpollution source. For example, you may typically operate your source nine hours a day (8:00 am to 5:00 pm), five days a week (Monday through Friday) and 50 weeks a year (closed for a week in July and December). Oryou may operate seasonally, for 12 

### hours a day, seven days a week, for a four-month period. Ifyou frequently have to use double shifts, or seasonally increase yourhours perday, then include this in your typical schedule. However, ifyou have to authorize overtime only infrequently, then do not include that in your typical schedule. D List ofestimated efficiency ofairpollution control equipment under present or anticipated operating conditions Ifyou use any air pollution control equipment, such as multiclones, baghouses, scrubbers, or thermal oxidizers, then provide a list ofthe equipment along with the estimated control efficiencies. These estimatedcontrol efficiencies must be for your present operating conditions, or ifyou are not currently operating normally, for your anticipated operating conditions. The list must include sufficient information about the emission control equipment (make, size, etc.) to enable EPA to identify them ifwe inspect the source. D Estimates ofthe total actual emissions from the air pollution sourcefor the following air pollutants: particulate matter, PMlo.PM2.S, sulfur oxides (SOx), nitrogen oxides (NOx), carbon monoxide (CO), volatile organic compound (VOC), lead (Pb) and lead compounds, ammonia (NII3), fluorides (gaseous and particulate), sulfuric acid mist (H2S04), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds,including all calculations for the estimates See the next section for detailed instructions on estimating yourtotal actual emissions. D Other (provide details) Ifthere is any other information aboutyour source or its operation that relates to air pollution that you wish to provide, then include that information in a separate attachment.

6FARRRegistration Instructions October 5, 2005 

### The following is an example ofthe type ofinformation to submit as attachments to your Registration Forms. Names and locations arefictitious and the description ofoperations, quantities, and emission factors are simplified for illustrative purposes. Theexample illustrates important concepts and demonstrates thecalculation ofthe quantitative indicators. While realistic, is not intended to reflect all the complexities and nuances associated with a particular situation. Narrative Description John's Auto Body Shop is a for-profit enterprise whose office is located at 101 Front Street, Toppenish, WA. This address is within the boundaries ofthe Yakama Reservation. This is also the mailing address ofthe business. Business phone number is 509-555-1212; fax is 509-555-1000. The owner ofJohn's Auto Body Shop is John Smith. His street and mailing addresses are the same as those for John's Auto Body Shop. The onsite manager ofoperations at John'sAuto Body Shop is John Smith. He is reachable at the addresses above, but also byphone at (509) 555-1212, extension 100. In addition to John Smith, John's Auto Body Shop employs 5journey-level body shop personnel and painters. They perform the hands-on work ofthe operation, includingbody repair and spray painting. John'sAuto Body Shop performs its auto refinishing work at the same street address as its office, 101 Front Street, Toppenish, W A but in reality the work is done at a body work/paint shop building physically located 50 yards away from the office, but on the same plot (i.e. same legal description ofproperty). Both ofthese sites are within the boundary ofthe Yakama Indian Reservation, as defined by the BIA. John's Auto Body Shop is one ofa halfdozen or so full-service auto refinishing shops in the Toppenish area. John's distinguishes itselffrom the competition by the thoroughness ofthe body prep work and by offering high-quality, multi-topcoat finishes. The growth ofthebusiness is limited by the market in the Toppenish area for work ofthis quality; the number ofvehicles worked has remained fairly constant for the last three years, and the owner ofthe business sees no change ofthis pattern so long as the customer base is limited to the greater Toppenish area. John's has plans for increasing market share by attracting customers from outside its normal market bounds, but atpresent John's Auto Body Shop operates a single shift of9 hours a day with occasional longer hours for special rushjobs. John'sAuto Body Shop follows this process in its auto refinishing work: Cars, trucks and other types ofvehicles arrive and are kept in storage until they come up in the work queue. Storage is a covered area 30 by 40 feet (forvaluable items) and an open lot 50 by 100 feet. Both areas are paved with asphalt. When ready to be worked on, the vehicle is driven to an area adjacent to and outside the entry door to the body/paint shop. After washing, the vehicle is driven into the shop. Body work is performed. Ifany disassembly is required, the components are removed at this time. If reusable and needing stripping sandblasting, the components are sent to a commercial stripping and sandblasting firm also located in Toppenish. Any patching, puttying, sanding or grinding that can be done whileparts are stripped, or until replacements arrived, is performed. When parts return from stripping. or new parts arrive, the vehicle is reassembled; welding (ifneeded) is performed, and additional patching may be done. 

### Ifbody work needs to wait for parts to catch up, the vehicle is moved offthe 7FARR Registration Instructions October 5, 2005 process line; there is room for 3 vehicles to be stored within the shop waiting for completion ofbody work. All body work, including storage, is done within a 30by 30 areajustinside the garage entry doors. When all body work onthe vehicle is completed, it is moved forward about 20 feet and prepared for painting. This includes washing theupper portion (by spraying) with a solvent. The underbody is degreased by spraying and manually with scrub brushes. Solvent from spraying escapes into the air around the work station. Solvent manually applied is somewhat (minimally) collected in a catchbasin, from which it is laterremoved bypumping. The vehicle rolls forward another 20 feet and undergoes an application ofpre-coat. This is allowed to airdry. Pre-coat is appliedby spraying, including the underbody. The spraying is somewhat controlled by plastic sheets which are hung from overhead fasteners to create temporary enclosure around the pre-coat area. After application ofthe pre-coat, the plastic sheets are removed to let air circulation dry the vehicle. The vehicle is moved forward 20 additional feet to the priming area. Again, plastic sheets are hung around the vehicle to create temporary walls while the vehicle is sprayed with primer, and are removed to allow drying. Topcoat is applied at one oftwo workstations located behind an interior wall from the pre-coat/priming areas. This area is large enough to hold up to two cars being worked on simultaneously, with room to park another two cars out ofrange ofspray guns while paint is drying. Multiple topcoats are applied, with vehicles being cycled in and out ofthe work stations, and to and from temporary storage. Depending on the type ofwork being done, the vehicle may be air-dried, or manually pushed into a drying oven. Each topcoat is followed bya drying period. Finally, the vehicle is released, either directly to the owner orback into under-cover storage awaiting pickup. Cleanup ofpaint guns is done after eachjobbyrunning solvent through the gun, under pressure, until all paint is expunged. No solvent is recovered from this operation. Solvent recovery from degreasing is done at the end ofeach day. Cleanup ofleaks and spills from paint cans, or from transferring paint from cans to gun canisters, is done immediately using solvent. Materials are purchased and are held in inventory at the body/paint shop. A formal inventory checkout system has been implemented and materials used for ajob are rigorously recorded. No significant spillage or leakage problems have been reported from storage. John's Auto Body Shop uses equipment which was purchased in the mid-1990s for all its spray operations. Exact make and model information does not seem to be available. No spraybooths are used. No air pollution control is in place. Within the body/paint shop, overhead fans and open windows on three walls provide air movement. Workers wearbody suits and respirators while working on vehicles, Three ofthe work staffwould be considered to be fully experienced (5 ormore years in the business); the remaining two individuals are learning their craft on-the-job under the tutoring ofthe more experienced workers. While the five workers rotate among the workstations so as to provide overlap and coverage; there is also some specialization among them.



### 8FARRRegistration Instructions October 5, 2005 

### "John's Auto Body Shop" - Example Process Flow Chart 

# l Prepare

body: disassemble

Prepare surfaces: degrease

Apply Precoat

Apply primer

Apply finish coat(s)

+-­ 

### Air dry Oven dry

Release to Customer

# ~ 9F ARR Registration Instructions October 5, 2005 

### John's Auto Body Shop - Example Plot Plan

p 

### autos awaiting work

windows

# ~ bodywork

sanding. grinding.**~** 

### door in**assemb~y** dust '-­ 

# -

alley paint inventory

cleanup

office finish VOC



### finish

VOC 

### pre­ ,­ 

### coat VOC



### pnme VOC



### door out 

### .­

parking for customers

city street 10 r 

### o p



### n e windows windows

degrease! slIrfHCe solventslVOC



### w i 

# J n 

### d o w 

# o

ovenFARR Registration Instructions October 5, 2005 John's Auto Body Shop - Example Emissions Worksheet for Process Steps and Pollutants (CY 2003 actual amounts used)

Process Step Type of material Material usage/ year Material UOM Pollutant Emission Factor (pollutants perunit of material used) Emission Factor UOM Lb pollutants emitted/year w/o controls Tons pollutants emitted/year w/o controls Air pollution control equipment Control equipment efficiency Pollutants emitted/ year with controls Bodywork Sanding minimal PM negligible none Degrease/surfaceprep Solvent 100 gallons VOC 6.6 Ib/gallon 660 0.33 none Pretreatment Pretreatment Coat 3000 gallons VOC 6.5 Ib/gallon 19500 9.75 none Precoat 3000 gallons VOC 5.5 Ib/gallon 16500 8.25 Prime PrimerlPrimer Surface 3000 gallons VOC 4.8 lb/gallon 14400 7.2 none Primer Sealer 3000 gallons VOC 4.6 lb/gallon 13800 6.9 Finish coat Three orfour stage topcoat system 5000 gallons VOC 5.2 lb/gallon 26000 13 none Dry Included above none Cleanup Solvent 100 gallons VOC 6.6 lb/gallon 660 0.33 none Storage Paints/Solvents negligible none {Total}

, 91520 45.76

Parking lot paved Heat source electrical



### 11FARRRegistration Instructions 10/0512005 

### C. TABLE OF ANNUAL EMISSIONS The initial registration and annual registration must include an estimate ofactual emissions taking into account equipment, operating conditions, and air pollution control measures. For an existing air pollution source that operated during the calendar yearpreceding the initial registration or annual registration submittal, the actual emissions are the actual rate ofemissions for the preceding calendar year and must be calculated using the actual operating hours, production rates, in-place control equipment, and types ofmaterials processed, stored, or combusted during the preceding calendar year. For a new air pollution source that is submitting its initial registration, the actual emissions are the estimated actual rate ofemissions for the current calendar year. The procedure for estimating actual emissions for your airpollution source involves five steps: Step 1: Conduct a source-wide inventory ofair pollutant emitting equipment and activities. Step 2: Identify the emission estimation method that you will use for each piece ofequipment or activity.
. Step 3: Gather the records for the appropriate calendar year that are needed for the chosen emission calculation methods. Step 4: Calculate the actual emissions for each piece ofequipment and activity. Step 5: Sum the emissions from all equipment and activities at your source. 

### STEP 1: Conduct a source-wide inventory The list ofair pollution generating equipment and activities developed above is your source-wide inventory ofair pollution generating equipment and activities. 

### STEP 2: Identify the emission estimation methods The emission estimates mustbe basedupon actual test data or, in the absence ofsuch data, upon procedures acceptable to the Regional Administrator. Any emission estimates submitted to the Regional Administrator mustbe verifiable using currently accepted engineering criteria. The following methods are generally acceptable for estimating emissions from air pollution sources:
• Source-specific emission tests; • Mass balance calculations; • Published, verifiable emission factors that are applicable to the source; • Other engineering calculations; or • Otherprocedures to estimate emissions specifically approved by the Regional Administrator. Further information on emission factors and other approaches to estimating actual emissions can be found on EPA Region 1O's FARR Registration web page: http://yoscmitc.cpa.gov/RIO/AIRPAGE.NSF/wcbpagc/FARR+Rcgistration+Program

12FARRRegistration Instructions 10/05/2005 

### STEP

### 3: Gather appropriate records With the exception ofin-stack continuous emission monitors, all emission estimate methodologies require you to have records ofactivity levels for your equipment orair pollution generating activities, such as the type and amount offuel burned, the amount ofraw materials processed or stored, orthe amount offinal product produced. You will need to collect and retain records ofthe information used in your chosen emissions estimation method. These records will need to cover a calendaryear (January 1through December 31) and will need to beretained for five years as required by EPA's Registration Rule. STEP

### 4: Calculate actual emissions for each piece ofequipment and activity Once you have determined which emissions estimation method you will use and have gathered your activity records for each piece ofair pollutant emitting equipment and activity, it is a simple process to calculate the actual emissions for the calendaryear. Since each piece ofequipment or activity will emit one ormore ofthe 

### 14 airpollutants required to be reported, it is recommended that you use a spreadsheet ortable structure to keep track ofthe emissions from each piece of equipment and activity. 

### Itis then easy to sum all ofthe emissions from all equipment and activities to get your source-wide totals. The following is an example ofhowthis can be done: ExampleWorksheet for Actual Emissions from Equipment and Activities for a Source with 

### Mu

### If Iple



### I Po

### IIut

### ant

### s Pollutant Equipment 1 

### Equipment

# 21 Activity 1 Activity 2 TOTAL PM 10.00 15.00 PMJO 5.00 1.00 9.00 PM2.5 

### 2.00 3.00 5.00 SOx 20.00 20.00 NOx 

### 10.00 10.00 CO 10.00 10.00 VOC 1.00 8.00 9.00 Pb .10 .10 NH3 3.00 3.00 Fluorides 1.00 1.00 H2SO4 .10 .10 H2S 1.00 1.00 TRS 1.00 1.00 RSC 1.00 1.00

13FARR Registration Instructions 10/05/2005 

### STEP 5: Sum actual emissions for entire source The following table should be completed by inserting estimates ofthe total actual emissions in tons/year for all pollutants contained inyour worksheet stated above. 

### Exam Ie Summar Table for a Source with Multiple Pollutants Pollutant Total Emissions PM 

### 15.00 PM 10 

### 9.00 PM2.5 

### 5.00 SOx 20.00 NOx 

### 10.00 CO 

### 10.00 VOC 

### 9.00 Pb 

### .10 NH3 

### 3.00 Fluorides 

### 1.00**~---r------------~** 

### .1 

### 1.00 1.00 1.00 

### Definition of acronyms PM PM 10 

### PM2.5 

### SOx NOx 

### CO VOC Pb 

### NH3 

### Fluorides H2S04 H2

### S TRS RSC Particulate Matter Particulate Matter less than 

### 10 microns in size Particulate Matter less than 

### 2.5 microns in size Sulfur Oxides Nitrogen Oxides Carbon Monoxide Volatile Organic Compound Lead and lead compounds Ammonia Both gaseous and particulate Sulfuric Acid Mist Hydrogen Sulfide Total Reduced Sulfur Reduced Sulfur Compounds.

14FARR Registration Instructions 10/05/2005 

### Annual Reporting Requirements for Part 71 Sources Sources with Federal Operating Permits (Part 71 Permits) are exempt from all ofthe requirements ofthe Registration Rule except for the annual reporting oftheir actual emissions. Thisrequirement is in addition to the Part 71 Permitrequirement to report certain emissions for fee purposes. Part 71 sources mustreport their actual emissions at the same time as they are required to report their fee calculations. Many ofthe same pollutants are required to be reported bythe Registration Rule and the Part 71 fee calculations. Forthese pollutants, the same approach for calculating actual emissions will be acceptable for both requirements. Butthere are some pollutants that are required to be reported by the Registration Rule and others that are required to bereported under the Part 71 program for fee purposes. These pollutants are shown in the following table.



### Pollutants Re uired to be Re orted underRe Pollutant Registration Rule PM x

Dioxins and Furans 189 HAPs hazardous air x x x 

### x x x 

### x x x 

### x x x 

### x x x x x
x x
x x x 

### x x 

### x x x 

### Note that under the Part 71 program, emissions greater than 4000 tons peryear ofany single pollutant are not counted for fee purposes. Also, emissions ofpollutants that could be included in more than one category are not counted twice for fee purposes. Finally, emissions from insignificant emission units can be excluded from fee calculations. 

### Confidential Treatment ofInformation You may assert a business confidentiality claim covering anyportion ofthe submitted information as provided in 40 C.F.R. part 2, subpart B. Please submit any information you claim as confidential business information separately, along with your claim ofconfidentiality. Note that emissions data and information necessary to determine emissions is not entitled to confidential treatment. Failure to assert a claim inthe manner described in 40 C.F.R. part 2, subpart B allows the submitted information to be released to the public without further notice. 15FARRRegistration Instructions 10/05/2005 

### Information subject to abusiness confidentiality claim may be disclosed by EPA only to the extent set forth in the above-cited regulations.
D. OWNEROROPERATOR CERTIFICATION OF TRUTH, ACCURACY AND COMPLETENESS. This section mustbe completedby eitherthe owner ofthe source or the operator ofthe source, as identified in Section A. above. Ifthe owner or operator is an individual or sole proprietorship, then that individual or sole proprietor must be the certifying officiaL Ifthe owner or operator is apartnership, then a general partner must be the certifying official. Ifthe owner or operator is a corporation, then the certifying official shouldbe a high-level official within the corporation who has the authority to ensure compliance with air quality requirements for the source. Certifying Official Information: Identify the certifying official and provide contact information. Name: (Last)_-=S.:..:.;m:.:...:it:..:..;h,--_(First)

__**J;:,.;o:.:.h~n** 

### __(Middle) Edward Title Owner Street orP.O. Box,

__----'l::..;:O::..;:l:....:F:....:rc..::o'-'-n:...:..tc..::S:::...;t:...:..r..=e.=;et-=--

___________ City

__ T";"";o"""p"""p=en;,,,;,;;i=sh..:...-

___County_--'-Y=ak;,,;,;i,;,:,,m=a

__State 

### WA ZIP 

### 98948 ­ Telephone ( 

### 509) 

## 555

- 1212 Ext. 

### 100 Facsimile ( 

### 509 ) 

## 555 -1000 e.mail address**_-*****j.:..oh:..:,:n:.:.,;@:=:..."j,.:jo::.!,h.:..:,.n:::::s.:::au::..:t:....:o:..:b;.:::,o.::,dys..:.s::.!,h.:,::o:.r:p.:.::.c:..:::o ..:.:.m~**  

### Certification ofTruth, Accuracy and Completeness: The Certifying Official must sign this statement after the form is completed. I certify that, based on information and beliefformed after reasonable inquiry, the statements and information contained in these documents are true, accurate and complete. Name (signed) Name (printed or typed)

__----=-J..;:;"oh;";,;n;";,,..=E=dw"'-a=r.....;:d;;,,,,;S;;;;;.;m=.;..:.it..;.;,h Date_I_I 03**1.-:;2=0=0~7** 

### __ Return completed forms and attachments to: EPA Region 10 (OAWT-107) 

### FARR Registration Coordinator Office ofAirWaste and Toxics 1200 

### Sixth Avenue Seattle, W A 98101

16F ARR Registration Instructions 10/05/2005 

## REPORT OF CHANGE OF OWNERSHIP (EPA Form 7630-5) After initial registration, submit a Report ofChange ofOwnership in writing within 90 days after the effective date ofchange ofownership ofthe business orfacility. Reports mustbe submitted on the EPA forms. Copies ofthe report forms maybe obtained online at EPA Region 1 O's web site orby calling EPA at the number listedbelow. The EPA Region 10 "FARR" website www.cpa.gov/rlOeartb/FARR is available for additional information and contains links to otherhelpful websites, including the EPA Region 10 Registration Web Page. Atthis web page you will find sample calculations for determining your source'spotential to emit and for calculating actual and estimated emissions. In addition, there are links to specific sites to assistyou in completing the registration forms. Assistance can also be obtained by calling the "FARR" hotline, 1-800-424-4372 and asking for help with "FARR" registration forms. Complete Section A, update anyinformation in Section B that has changed as a result ofthe change ofownership, including the Table in Section C, and complete and sign Section D. Mail the completed form and attachments to the address listed at the end ofSection D.
A. GENERAL INFORMATION In this section you will provide information about the name ofthe previous ownerandbusiness, the location ofyour air pollution source, the type ofbusiness that is conducted there, the owner and operator ofyour source and the contact information for certain people responsible for the operation ofthe source and compliance with airpollution requirements. The Previous Source (Facility) Name is the name ofthe business when it was operatedby the previous owner. The Previous Owner's Name is the name ofthe individual, sole proprietorship, partnership, or corporation that previously owned this business. See Section A. 

### GENERAL INFORMATION in the instructions for INITIAL/ANNUAL SOURCE REGISTRATION (EPAForm 7630-4) for instructions on completing the rest of this section. The Effective Date ofChange ofOwnership is the date that the new owner is responsible for the operation ofthe business and compliance with applicable airquality requirements.

17FARRRegistration Instructions 1010512005 

### The following is a sample ofhow to complete this portion ofthe Report ofChange of Ownership form. Identifying Information

Previous Source (Facility) Name

__**~;:..J.=.o.:..:.h:.:.n'.:.s..:.A.:.:u:..:t~o~B::;.;o:.;d::..yI--.:S;.:..h:.:o+::p~**

### ______ Previous Owner's Name John Smith**------=~~~~~--------** 

### New Source (Facility) Narne

____**---=S;.;::a~IIy.l_':.s**

### ..;.,A.;,:u:.:,t.=,o-=B;.;::o;.;::d+-y...::S:;.:.h.:,.::o+:p

_____ Air Quality Operating PermitNo. (ifapplicable) 

## NIA Nature ofthe Business Auto body repair and refinishing SIC Code 7532 Telephone ( 509) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555

- 1000 Source Physical Address: Street

__...;;;l=O.;;;..l....:..F....:..r..:;.o.;..:.nt..:.......;::S;..:.t.;..r=ee.;;;..t.:....-

________ City

__**T..:....;o::..j:p+:p=en:..:..:i=sh~_County** 

### Yakima State WA ZIP 98948 Indian Reservation Name Yakama Reservation Compliance Contact Person Sally Jones Owner Title_------":....:..:...:c..:..:::.:.

___ (Local Person responsible for source compliance with this rule) 

### Telephone ( 509) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555

- 1000 Contact Person Mailing Address: Street (or PO Box #)**_.....:1:..::0:..::1:....:F'-!r~o:;.:.n.:...:.t.....:S::;.;t.:....:r....;:e:..::e:...!t**

### __ City

__**T..:....;o::..j:p:..a::p=en:..:..:i=sh~_** 

### County Yakima State WA ZIP 98948 e.mail address Sally@sallysautobodyshop.com

18

### -------------

----------------- ------------

------------- FARR Registration Instructions October 5, 2005


### Owner's Name 

### Sally Jones Telephone ( 509 ) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555

- 1000 Owner Mailing Address: Street (orPO Box #) 

### _--'l;.;::O;.;::l;...:F;...:r;...:o:..:..n:....:.t....;:S=-t.:....:.r...;:e;.;::e;..:.t

_____ City

__**T.:....:o::..j:p~p=en:...:..;i=sh~_County** 

### Yakima State 

### WA ZIP 98948 e.mail address e.mail address Sally@sallysautobodyshop.com Contact

__

### =S-=a.:..:.lly,/......:!J-=o:..:..n:..::e=s

________Title

___**O=w~n:..::e;:...r**

### ___ (Person authorized to receive requests for data and information) 

### Telephone ( 509 ) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555

- 1000 Contact Person Mailing Address: Street (or PO Box #)

__

### ---"'-lO.;;;...;;;..l..:..F..:..r..:..o:....:.nt.:........;:;S'-"t..;...r=ee=t..:......-
__ City

__**T...;..o.;;.jp~p:..;:e;.:..:n~is:..:..h~_** 

### County Yakima State 

### WA ZIP 98948 e.mail address Sally@sallysautobodyshop.com Operator'sName

___**=S=a'-'-m=e;....;a=s;;...o=w:..;..;...;.ne=r~**

### ____(Ifdifferent from owner) New Telephone (,-_-,)
______Ext.
___Facsimile**('-_~)** 

### _______ Operator Mailing Address: Street (orPO Box #)

_______________ 

### City
_________County

______State
___ZIP

______ e.mail address Contact 

### Title (Person authorized to receive requests for data and information) 

### Telephone**~)** 

### ______ Ext.
____Facsimile (,-_-,)

_______ Contact Person Mailing Address: Street (or PO Box #)

_____________ 

### City
_________County

_______State
___ZIP

___ e.mail address
Effective Date ofChange ofOwnership. 

### Date. 06 

### I 01 

### I 2008

19FARR Registration Instructions October 5, 2005 

### B. ATTACHMENTS Update (in separate attachments to this form) any ofthe information listed below that has changed as a result ofthe change ofownership. See Section B. ATTACHMENTS in the instructions for INITIAL/ANNUAL SOURCE REGISTRATION (EPA Form 7630-4) for instructions on completing this section.

Include any ofthe followine: information as attachments to this form that requires updatine: 

### as a result ofthe change ofownership. D 

### Process flow chart identifying all processing, combustion, handling, storage, and emission control equipment D 

### Narrative description ofthe production processes and air pollution control equipment D 

### List ofall emission units and airpollution generating activities; include model and serial numbers for portable equipment D 

### Plot Plan • Location ofall emission units and airpollution generating activities • Property lines for the airpollution source • Elevation above grade for each emission release point • Distance and direction to nearest residential or commercial property. D 

### Type and quantity offuels, including sulfur content offuels, used on a daily, annual and maximum hourly basis D 

### Type and quantity ofraw materials used orfinal product produced on a daily, annual and maximum hourly basis D 

### Typical operating schedule, including number ofhours per day, number ofdays perweek and number ofweeks peryear D 

### List ofestimated efficiency ofairpollution control equipmentunder present oranticipated operating conditions D 

### Estimates ofthe total actual emissions from the airpollution source for the following air pollutants: particulate matter, PMlO, 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 (H2S04), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds, including all calculations for the estimates. D 

### Other (provide details).



### 20FARRRegistration Instructions October 5, 2005 

### C. TABLE OF EMISSIONS
Pollutant TotalEmissions PM PMIO 

### PM2.5 SOx NOx CO VOC Pb NH3 Fluorides H2SO4 H2S TRS RSC 

### Definition of acronyms PM Particulate Matter PM 10 

### Particulate Matter less than 10 microns in size PM2.5 Particulate Matter less than 2.5 microns in size SOx Sulfur Oxides NOx 

### Nitrogen Oxides CO Carbon Monoxide VOC Volatile Organic Compound Pb Lead and lead compounds NH3 Ammonia Fluorides Both gaseous and particulate 

### H2

### S04 

### Sulfuric Acid Mist H2S Hydrogen Sulfide TRS Total Reduced Sulfur RSC Reduced Sulfur Compounds.
Confidential Treatment ofInformation You may assert a business confidentiality claim covering anyportion ofthe submitted information as provided in 40 C.F.R. part 2, subpart

### B. Please submit any information you claim as confidential business information separately, along with your claim of confidentiality. Note that emissions data and information necessary to determine emissions is not entitled to confidential treatment. Failure to assert a claim in the manner described in 40 C.F.R. part

### 2, subpart B allows the submitted information to be released to the public without further notice. Information subject to a business confidentiality claim may be disclosed by EPA only to the extent set forth in the above-cited regulations.

21FARR Registration Instructions October 5,2005 

### D. OWNER OROPERATOR CERTIFICATION OF TRUTH, ACCURACY AND COMPLETENESS. 

### This section must be completed by either the owner ofthe source or the operator ofthe source, as identified in Section A. above. Ifthe owner or operator is an individual or sole proprietorship, then that individual or sole proprietor must be the certifying official. Ifthe owner or operator is a partnership, then a general partner must be the certifying official. If the owner or operator is a corporation, then the certifying official should be a high-level official within the corporation who has the authority to ensure compliance with air quality requirements for the source.
Certifying Official Information: 

### Identify the certifying official and provide contact information. Name: (Last)

__**~J..,;:o;.:..;n~e:..s**

### ___(First) Sally 

### (Middle)_------"M"'-'a-'-e'"---_ Title Owner 

### Street or P.O. Box 101 Front Street**--------~~~~~~~~----------------** 

### City

__ T.:....:0:..a:p:..j:;p=en:..:..:.i::..:sh...!.......-_County Yakima 

### State WA 

### ZIP 98948 

### Telephone ( 509) 555 - 1212 

### Ext. 100 

### Facsimile ( 509 ) 555 - 1000 

### e.mail address

__--..:S=.;a::.:'.:..t1y...::@::..;s::.;:a::.:..;II'..J-y.=.;sa=.;:u::..:.t-=.o=-bo:::,.;d::...yt..;:s;.:..;h:..::.o&:-P .,-=c-=..om:..!..!.­ 

### Certification ofTruth, Accuracy and Completeness: 

### The Certifying Official must sign this statement after the form is completed. I certify that, based on information and beliefformed after reasonable inquiry, the statements and information contained in these documents are true, accurate and complete. Name (signed)

______________________________ Name (printed or typed)

__-----'S::;.;a::..:.',..ly...",J..,;:o;.:..;n=es=----

___Date 08 / 01 / 2008

Return completed forms and attachments to: 

### EPA Region 10 (OAWT-l07) F

ARR Registration Coordinator Office ofAir Waste and Toxics 1200 Sixth Avenue Seattle, WA 98101

22FARR Registration Instructions October 5, 2005 

## REPORT OF CLOSURE (EPA Form 7630-6) Except for regular seasonal closures, after initial registration, submit a Report ofClosure in writing within 90 days after cessation ofall operations. Reports mustbe submitted on the EPA forms. Copies ofthe report forms may be obtained online atEPA Region 10's web site or by calling EPA at the number listedbelow. The EPA Region 10 "FARR" website www.epa.gov/r1Ocalih/FARR is available for additional information and contains links to other helpful websites, including the EPA Region 10 Registration Web Page. At this web page you will find sample calculations for determining your source's potential to emit and for calculating actual and estimated emissions. In addition, there are links to specific sites to assist you in completing the registration forms. Assistance can also be obtainedby calling the "FARR"hotline, 1-800-424-4372 and asking for help with "FARR" registration forms. Complete Section A, providethe information in Section B, complete and sign Section C, and mail thecompleted form and attachments to the address listed at the end ofSection C.
A. GENERAL INFORMATION The Effective Date ofthe Source Closure is the date when all activities related to the operation ofthe business and all activities related to the shutdown ofoperations at the source have ceased. See Section A. GENERAL INFORMATION in the instructions for INITIAL/ANNUAL SOURCE REGISTRATION (EPA Form 7630-4) for instructions on completing the rest of this section.

23F ARR Registration Instructions October 5, 2005 

### The following is a sample ofhow to complete this portion ofthe Report ofClosure form. Identifying Information Source (Facility) Name,

____**s::::.a~I~lyr...::'s::....:...:A~ut.!..:o~B.::::.;od::..yI......:::::S..:..:h.::::.;opl=__**

### ______ Effective Date ofthe Source Closure --.!Q.j 

### 01 I 2010 

### Air Quality Operating Permit No. (ifapplicable)

___..... 

## N

..... I

__ A

_____________ Nature ofthe Business

__**..:..A..:,:u:..:.t..:,o....:::b:.,::o;,.::d:.t-y..:..r,.:;e.r::.;pa::,:i.:...r;,.::a:.:...:.nd=:....:..r,.:;ef..!..:i..:..:n.:..::is..:..:h~in.:,;:i9L...:S::::.:I::.:C:::...:C.::::.;od~e::::.....:...7,.:;5,.:;3-=2~**

### __ Telephone ( 509 ) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555 -1000 Source Physical Address: Street

___-=l;,;:O;,;:l
...... F....:,r....:::o..:.,:n..:,.t...::S:..:,t..:,.re.;:;,e;:;"t:..--

_______ City

__**T..:....;o=.,:p~p..:.en:...:..:i:.:sh:..:...-_** 

### County Yakima State WA ZIP 98948 Indian Reservation Name

___--..:.Y.::::,a:.,:;ka=:.m.!,.:;a:::....:.;R:,:::e::::,se:::;.:r:..,:v:..:::a:.:.t.:,::io..:..:n'---

_______ Compliance Contact

__---=S;,;:a""'"
..... Title

__..-.:O:;..:;w.:.:,n.:.;:e:;:..r

___**y-"J::....;:o::;.:,n.:.::e:.:;s~**

### __ (Local Person responsible for source compliance with this rule) 

### Telephone ( 509 ) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555 -1000 Contact Person Mailing Address: Street (orPO Box #)

__

### .;;.;10;;..;l;....oF:...;r:.....:o;.:..n:..:.,t...;;:S:;..:t..:,.r=ee;:;"t:..--
__ City

__**T..:....;o=.,:p~p=en=i=sh:..:...-_County** 

### Yakima State WA ZIP 98948 e.mail address Sally@sallysautobodyshop.com

24-------------

---------------- 

### ------------

--------- ------- --- ---- F

ARR Registration Instructions October 5, 2005 

### Owner's Name Sally Jones Telephone ( 509) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555

- 1000 Owner's Mailing Address: Street (orPO Box #)**_---=l:..:0;..:1....:.F....:.r...::o:..:..n:..:..t...::S~t:..:..r...::e:..:e:..:.t_** 

### City

__ T....;...o,;;.,jp"'"'p:;...;:e;;.,;..;n=is:..;.,.n'------_ County Yakima State 

### WA ZIP 98948 e.mail address Sally@sallysautobodysnop.com Contact

___**---=S;..:a~lI./-y...::J...::o:..:..;n:.:e.:..s**

### _____Title_--=O....:.;w:...:..n:..;;;e""'r
__ (Person authorized to receive requests for data and information) 

### Telephone ( 509) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555

- 1000 Contact Mailing Address: Street (or PO Box #)

__**-=-lO=..;l:......:....F.:....ro:..:n..:...:t~S:..:..:tr...::e:.::e:..:.t**

### __ City

__**T.:....:o~p+p=en:..:..:i.::.;sn~_** 

### County Yakima State 

### WA ZIP 98948 e.mail address Sally@sallysautobodysnop.com Operator's Name

____**........::::S~a::..:.m:..::e:....:a=s::.....:..ow~ne:::::;r~**

### ______(Ifdifferent from owner) Telephone**~)** 

### ______ Ext.
___Facsimile**~)** 

### _______ Operator's Mailing Address: Street (orPO Box #)

_____________ 

### City
_________County
______State ZIP

--­ 

### e.mail address Contact Title (Person authorized to receive requests for data and information) 

### Telephone**(~_~)** 

### ______ Ext.
___Facsimile**~)** 

### _______ Contact Mailing Address: Street (or PO Box #)

______________ 

### City County State ZIP e.mail address

25I FARR Registration Instructions October 5,2005 

### B. REPORT OF 

### CLOSURE. Provide a written description ofclosure activities and/or care and maintenance activities performed at the source and a statement describing the duration ofthe source closure. (e.g. temporary vs. permanent). This should include a description ofany partial operation ofthe source, any temporary storage ofequipment or materials, and any demolition activities that will occur at the plant site.


### ConfidentialTreatmentofInformation You may assert a business confidentiality claim covering anyportion ofthe submitted information as providedin 40 C.F.R. part 2, subpart B. 

### Please submit any information you claim as confidential business information separately, along withyour claim of confidentiality. Note that emissions data and information necessary to determine emissions is not entitled to confidential treatment. Failure to assert a claim in the mannerdescribed in 40 C.F.R. part 2, subpart B allows the submitted information to be released to the public without further notice. Information subjectto a business confidentiality claim may be disclosed by EPA only to the extent set forth in the above-cited regulations.

26FARR Registration Instructions October 5, 2005 

### C. OWNER OR OPERATOR CERTIFICATION OFTRUTH, ACCURACY AND COMPLETENESS. This section must be completed by either the owner ofthe source or the operator ofthe source, as identified in Section A. 

### above. Ifthe owner or operator is an individual or sole proprietorship, then that individual or sole proprietor must be the certifying official. Ifthe owner or operator is a partnership, then a general partner must be the certifying official. If the owner or operator is a corporation, then the certifying official should be a high-level official within the corporation who has the authority to ensure compliance with air quality requirements for the source.


### Certifying Official Information: Identify the certifying official and provide contact information. Name: (Last)

__

### ....:::J:.....;:o;...:..;n=e=.s

___(First) 

### Sally (Middle**)_------'-M.;..:.a=e~_** 

### Title 

### Owner Street or P.O. Box 

### 101 Front Street**--------~~~~~~~~----------------** 

### City

__**T..:....;o:::..j:p+p=e:...:..:ni=sh~_** 

### County 

### Yakima State 

### WA ZIP 

### 98948 Telephone ( 

### 509 ) 555 - 1212 Ext. 

### 100 Facsimile ( 

### 509 ) 555 - 1000 e.mail address

__

### ---"'S=a=I.:..J,ly....:::@:::..:s=a::.:.;lI
....**y=sa=u::...!t..:.o=b=.od=y~s:..:..h=o~p=.c..:.o!.!,;m'** 

### Certification ofTruth,Accuracy and Completeness: The Certifying Official must sign this statement after the form is completed. I certify that, based on information and beliefformed after reasonable inquiry, the statements and information contained in these documents are true, accurate and complete. Name (signed)

____________________________ Name (printed or typed)

__

### ------'S;;...;;a=lI...,..y....:::J;.....;;o..;..;n=es"'---

___Date

# -.1LI**~2010**


### Return completed forms and attachments to: EPA Region 10 (OAWT-I07) FARR Registration Coordinator Office ofAir Waste and Toxics 1200 Sixth Avenue Seattle, W A 98101

27FARR Registration Instructions October 5, 2005 

### [This page deliberately left blank.]



### 28FARRRegistration Instructions October 5, 2005 

## REPORT OF RELOCATION (EPA Form 7630-7)
For any source relocation after initial registration, submit a Report ofRelocation in writing no later than 30 days priorto relocation ofthe source. Reports must be submitted on the EPA forms. Copies ofthe report forms may be obtained online at EPA Region 10's web site orby calling EPA at the number listed below. The EPA Region 10 "FARR" website www.cpa.gov/rlOcaI1h1FARR is available for additional information and contains links to otherhelpful websites, including the EPA Region 10 Registration Web Page. Atthis web page you will find sample calculations for determining your source's potential to emit and for calculating actual and estimated emissions. In addition, there are links to specific sites to assist you in completing the registration forms. Assistance can also be obtained by calling the "FARR" hotline, 1-800-424-4372 and asking for help with "FARR"registration forms. Complete Section A, update anyinformation in Section B that has changed as a result of the change ofownership, including the Table in Section C, and complete and sign Section D. Mail the completed form and attachments to the address listed at the end ofSectionD. A. GENERAL INFORMATION In this section you will provide information about the previous location ofthe business, the new location ofyour air pollution source, and any changes to the type ofbusiness that is conductedthere or the contact information for certain people responsible for the operation of the source and compliance with air pollution requirements. The New SourcePhysical Address is the new location ofyourbusiness after the relocation. The Previous PhysicalAddress is the old location ofyourbusiness before the relocation. See Section A. GENERAL INFORMATION in the instructions for INITIAL/ANNUAL SOURCE REGISTRATION (EPA Form 7630-4) for instructions on completing the rest of this section. The Effective Date ofSource Relocation is the date thatbusiness operations begin atthe new location and airpollutant generating equipment or activities begin operation.



### 29FARR Registration Instructions October 5, 2005 

### The following is a sample ofhow to complete this portion ofthe Report ofChange of Ownership form.

Identifying Information Source (Facility) Name

___**...:S:::.:a~lI:..s..y-='S...:..A..:.:u:.:.t.::..o-=B:;.::o-=d./-y..::S~h:.:;o~p**

### _______ Air Quality Operating Permit No. (ifapplicable)

______ Nature ofthe Business Auto body repair and refinishing SIC Code 7532 Telephone ( 509 ) 555 -_1212 Ext. 100 Facsimile ( 509 ) 555 -1000 New Source Physical Address: Street

__----'2=.,;0::,.;2=-:..:M..:.;:a::.;.in:...:.....=S:..:.t.,.:...

____**City_--:..W:..;:a::.l:p:.::a..:....:to~**

### __County Yakima State WA ZIP 98951

­ Previous Physical Address: Street

__.:.lO:.;l::...:-F,:..:ro:.,:n..:..:t...,;S:::..t.:....:r..:e:.,:e:...:..t

____ City

__**T.:..;o:::.c:p:.c:p-=en:.:.:i.::.:sh~_County** 

### Yakima State WA ZIP 98948 Indian Reservation Name

__---"Y...=a:..:...;k:.;::a;..:..m=a

______________ Compliance Contact Person Sally 

### Jones**Tit1e._--=:O;.:.:w:.:..:n-=er~_** (Local Person responsible for source compliance with this rule) 

### Telephone ( 509 ) 555

- 1212 Ext. 100 Facsimile ( 509 ) 555 -1000 Contact Person Mailing Address: Street (or PO Box #) 

### 202 Main St**City_---:.W~ap~a:::..:t...::;o**

### ___County Yakima State WA ZIP 98951

­ e.mail address Sally@sallysautobodyshop.com

30

### -------------



### -------- ----- ----

---- FARR Registration Instructions October 5, 2005 

## Owner's Name

__-----=S:;;..;a;;.;.lI.y.....JJ::..;o:;.;;.n.;:.;::e=s

_____________ Telephone ( 

## 509) 555

- 1212 Ext. 

## 100 Facsimile ( 

## 509 ) 555

- 1000 Owner Mailing Address: Street (orPO Box #)

__**-=20=2..:..M::..:.a::.;i:.:..:n~S~t:..:..**

### ___ 

## City_----"W..::..a.p"""a::;:.:t....:::;o--_County Yakima State WA ZIP 98951

- e.mail address 

## Sally@sallysautobodyshop.com Contact Sally Jones

_____ (Person authorized to receive requests for data and information) 

### Telephone ( 

## 509) 555

- 1212 Ext. 

## 100 Facsimile ( 

## 509 ) 555

- 1000 ContactMailing Address: Street (or PO Box #)**_--=2:;;..;0:;..:;2:...;M:..:..:.:a:.:..!in..:....=S~t:.....**

### __ 

## CCity_--'-W:;..;;a""'p=a"-'to"---
__County

__ Y:....:a:,:.k.:.:.,:im:.:.,:a=--_ State WA ZIP 98951

- e.mail address 

## Sally@sallysautobodyshop.com Operator's Name

__**~S=am=e;...=a=s:....O=..:..:w~n:.:::e:.:....r** 

### (If

### different from owner) Telephone ('-_---')
_______Ext.
____Facsimile '-_-'

_______ Operator's Mailing Address: Street (orPO Box #)

_____________



### _________County

______State
___ZIP

___ e.mail address 

## Contact Title (Person authorized to receive requests for data and information) 

### Telephone**(~~)** 

### Ext. Facsimile



### ---- ---- '----'-- 

### ---­ ContactMailing Address: Street (or PO Box #)

_______



### _________County

______State
___ZIP

______ e.mail address


## Effective Date ofSource Relocation. Date.JQj

## 01 I 2009

31FARR Registration Instructions October 5, 2005 

### B. REPORT OF RELOCATION Provide a written description ofrelocation activities. Update (in separate attachments to this form) any ofthe information listed below that has changed as a result ofthe change of ownership. See Section B. 

### ATTACHMENTS in the instructions for INITIAL/ANNUAL SOURCE REGISTRATION (EPA Form 7630-4) for instructions on completing this section.

Include any ofthe following information as attachments to this form that requires updating as a result ofthe change ofownership. 

## o Process flow chart identifying all processing, combustion, handling, storage, and emission control equipment 

## o Narrative description ofthe production processes and air pollution control equipment 

## o List ofall emission units and airpollution generating activities; include model and serial numbers for portable equipment 

## o Plot Plan • Location ofall emission units and air pollution generating activities • Property Hnes for the air pollution source • Elevation above grade for each emission release point • Distance and direction to nearest residential or commercial property. 

## o Type and quantity offuels, including sulfur content offuels, used on a daily, annual and maximum hourly basis 

## o Type and quantity ofraw materials used orfinal product produced on a daily, annual and maximum hourly basis 

## o Typical operating schedule, including number ofhours per day, number ofdays perweek and number ofweeks peryear 

## o List ofestimated efficiency ofair pollution control equipment under present or anticipated operating conditions 

## o Estimates ofthe total actual emissions from the airpollution source for the following air pollutants: particulate matter, PMIO. PM2.5, sulfur oxides (SOx), nitrogen oxides (NOx), carbon monoxide (CO), volatile organic compound (VOC), lead (Pb) and lead compounds, ammonia (NH3), fluorides (gaseous andparticulate), sulfuric acid mist (H2S04), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds, including all calculations for the estimates. 

## o Other (provide details).

32FARRRegistration Instructions October 5, 2005 

### C. TABLE OF EMISSIONS
Pollutant Total Emissions PM PMJO 

### PM2.5 SOx NOx 

### CO VOC Pb NH3 Fluorides l
..LQ(l 

### H2S TRS RSC 

### Definition of acronyms PM PM 10 

### PM25 

### SOx NOx 

### CO VOC Pb NH3 Fluorides H2

### S04 

### H2S TRS RSC Particulate Matter Particulate Matter less than 10 microns in size Particulate Matter less than 2.5 microns in size Sulfur Oxides Nitrogen Oxides CarbonMonoxide Volatile Organic Compound Lead and lead compounds Ammonia Both gaseous and particulate Sulfuric AcidMist Hydrogen Sulfide Total Reduced Sulfur Reduced Sulfur Compounds.
ConfidentialTreatment ofInformation You may assert a business confidentiality claim covering any portion ofthe submitted information as providedin40 C.F.R. part 

### 2, subpart 

### B. Please submit any information you claim as confidential business information separately, along with your claim of confidentiality. Notethat emissions data and information necessaryto determine emissions is not entitled to confidential treatment. Failure to assert a claim in the manner described in 40 C.F.R. part2, subpart B allows the submitted information to be released to the public without further notice. Information subject to a business confidentiality claim maybe disclosed by EPA only to the extent set forth in the above-cited regulations.



### 33FARR Registration Instructions October 5, 2005 

### D. OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND COMPLETENESS. This section mustbe completed by either the owner ofthe source orthe operator ofthe source, as identified in Section A. above. 

### Ifthe owner oroperator is an individual or sole proprietorship, then that individual or sole proprietormustbe the certifying official. Ifthe owner or operator is a partnership, then a general partnermust be the certifying official. If the owner or operator is a corporation, then the certifying official should be a high-level official within the corporation who has the authority to ensure compliance with air quality requirements for the source. 

### Certifying Official Information: Identify the certifying official and provide contact information. 

## M

....._____ Name: (Last)

__**=J=on:..:.::e=s~** __

### (First) 

### Sally (Middle)

____

## ......ae _ Title 

### Owner Street orP.O. Box

____**---=2..:.0=2...:.M~a=i:.:...;n~S::;..t:..:.r..;::e;.;::;e..:..t**________ 

### City 

### Wapato County 

### Yakima State 

### WA ZIP 

### 98951 -_ Telephone ( 

### 509) 555 - 1212 Ext. 

### 100 Facsimile ( 

### 509 ) 555 - 1000 e.mail address

__**.-: S::.;a:::.:I.!./.ly.-::@::::..:s==a~II'..I-y.=.;sa=..::u::..!t..=;o.=.bo::.;d::.,y~s:..:..;h:..:.0.l::-p.~c=om** **:.!.!....** 

### Certification ofTruth, Accuracy and Completeness: The Certifying Official must sign this statement after the form is completed. I certifythat, based on information and**bel~ef**

### formed afterreasonable inquiry, the statements and information contained in these documents are true, accurate and complete.**Name,~,~~,,** 

### __,___________________________ Name (printed ortyped)

__**------"S=a=II'..I-y...;:J...;:o;.:.:ne=s~** ___

### Date 

### 08 /**~/** 

### 2009

Return completed forms and attachments to: EPA Region 10 (OAWT-107) F

ARR Registration Coordinator Office ofAirWaste and Toxics 1200 Sixth Avenue Seattle, W A 98101

34

### --------------------------

--------------------

-------------- Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

### UNITED STATES ENVIRONMENTAL PROTECTION AGENCY 

# &EPA REGION 10 FEDERAL AIR RULES FORINDIAN RESERVATIONS INITIAL / ANNUAL SOURCE REGISTRATION Applicability: Air pollution sources regulated by 40 Code ofFederal Regulations Part 49.138. 

### Please check box to show how you are using this form. DInitial Registration 

# DAnnual Registration INSTRUCTIONS: Complete applicable parts ofSections A, B, C and D.
A. GENERAL INFORMATION

Identifying Information Source (Facility) Name

_________________________ Air Quality Operating Permit No. (ifapplicable)

________________ Nature ofthe Business Telephone

_______ Facsimile

_______ Source Physical Address: Street

__________________ City
__________County

______State
____ZIP

________ Indian Reservation Name 

### Compliance Contact

____________Title

________ (Local Person responsible for source compliance with this rule) Telephone
_______Ext.

____ Facsimile

_______ Contact Person Mailing Address: Street (orPO Box #)

_______________ City
__________County
_______ State
____ZIP

________ 

### e.mail address

EPA Form 7630-4 Page I of6

## ---------------

------------ ----- ---



### -------------------

--------- -------------

-------------- Form Approved OMS 2060-0558 Approval Expires 5131/2011 

### A. GENERAL INFORMATION Coot. Owner's Telephone '-_-'
________Ext

____ Facsimile

_______ Owner Mailing Address: Street (orPO Box #)

_____________ City

________ County

________ State

___ ZIP

_______ e.mail address

______________ Contact 

# ---------.­ (Person authorized to receive requests for data and information) Telephone
_______Ext.
______Facsimile

_______ Contact Person Mailing Address: Street (or PO Box #)

_______________ City

________ _ _______ State

___ ZIP

________ e.mail address Operator's Name

___________________ (Ifdifferent from Owner). Telephone
________Ext.
_____Facsimile

_______ Operator'sMailing Address: Street (orPO Box #)

______________ State ZIP e.mail address Contact Title (Person authorized to receive requests for data and information) Telephone

_______ Ext.

____ Facsimile**~.** _________ Contact Person Mailing Address: Street (orPO Box #)

_________________ City

________ -- ••.1
_____________State

___ ZIP

________ e.mail address

EPA Form 7630-4 Page 2 of6Form Approved OMB 2060-0558 Approval Expires 5/31/20II 

### B. ATTACHMENTS

Include all ofthe following information as attachments to this form 

# o Process flow chart identifying all processing, combustion, handling, storage, and emission control equipment 

# o Narrative description ofthe production processes and airpollution control equipment 

# o List ofall emission units and air pollution generating activities; include model and serial numbers for portable equipment 

# o Plot Plan ./ Location ofall emission units and airpollution generating activities ./ Property lines for the airpoLLution source ./ Elevation above grade for each emissionrelease point ./ Distance and direction to nearest residential orcommercialproperty 

# o Type and quantity offuels, including sulfur content offuels, used on a daily, annual and maximum hourly basis 

# o Type and quantity ofraw materials used orfinal product produced on a daily, annual and maximum hourly basis 

# o Typical operating schedule, including number ofhours perday, number ofdaysper week and number ofweeks per year 

# o List ofestimated efficiency ofairpollution control equipmentunderpresent or anticipated operating conditions 

# o Estimates ofthe total actual emissions from the air pollution source for the following air pollutants: particulate matter, PMIO, 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 (H2S04), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds, including all calculations for the estimates 

# o Other (provide details) 

### Confidential Treatment ofInformation You may assert a business confidentiality claim covering any portion ofthe submitted information as provided in 40 C.F.R. part 2, subpart B. Please submit any information you claim as confidential business information separately, along with your claim ofconfidentiality. Note that emissions data and information necessary to determine emissions is not entitled to confidential treatment. Failure to assert a claim in the manner described in 40 C.F.R part 2, subpart B allows the submitted information to be released to the public without further notice. Information subject to a business confidentiality claimmaybe disclosed byEPA only to the extent set forth in the above-cited regulations.

EPA Form7630-4 Page 3 of6Form Approved OMB 2060-0558 Approval Expires 5/31120II 

### C. 

### TABLE OF ANNUAL EMISSIONS The following table should be completed by inserting estimates ofthe total actual emissions in tons/year for all pollutants contained in yourworksheet stated above.

•Pollutant Total Emissions PM PM 10 

### PM 2.5 iSOX



### . NOx

CO VOC Pb NH3 Fluorides H2SO4 H2S TRS RSC 

### Definition of acronyms PM PMIO 

### PM2.5 SOx NOx CO VOC Pb NH3 Fluorides H2S04 H2S TRS RSC Particulate Matter Particulate Matter less than 10 microns in size Particulate Matter less than 

### 2.5 microns in size Sulfur Oxides Nitrogen Oxides Carbon Monoxide Volatile Organic Compound Lead and lead compounds Ammonia Gaseous and particulates Sulfuric Acid Mist Hydrogen Sulfide Total Reduced Sulfur Reduced Sulfur Compounds

EPA Form 7630-4 Page 4 of6

### --------------------- Form Approved OMB 2060-0558 Approval Expires 5/31/20II 

### D. OWNER OROPERATOR CERTIFICATION OF TRUTH, ACCURACY AND COMPLETENESS

Certifying Official Information: Identify the certifying official and provide contact information. Name: (Last)
__ _____(First)

_______(,Middle)

_____
Street orP.O. Box Telephone '----'

______ Facsimile --'---- '---'---- ----­ e.mail

Certification ofTruth, Accuracy and Completeness: The Certifying Official must sign this statement after the form is completed. I certify that, based on information and beliefformed after reasonable inquiry, the statements and information contained in these documents are true, accurate and complete.**Name,~·l~** ..**~·_'** ___________________________________________ Name (printed ortyped)

________________,Date

__ I

__ I

_____
Return completed forms and attachments 

### to: EPA Region 10 (OAWT-I07) FARR Registration Coordinator Office ofAirWaste and Toxics 1200 Sixth Avenue Seattle, W A 98101

The public reporting and recordkeeping burden for this collection ofinformation is estimated at 5.61 hours on average Send comments on the Agency's need for this information, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use ofautomated collection techniques to the Director, Collection Strategies Division, US Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., •NW, Washington, D.C. 20460. Include the OMB control number 2060-0558 in any

correspondence. Do not send the completed form to this address.

EPA Form 7630-4 Page 5 of6Form Approved OMB 2060"()558 Approval Expires 5/31/2011
FARR REGISTRATION APPLICATION INSTRUCTIONS GENERAL INFORMATION IdentifyingInformation FACILITY Enterthe name and the correct street address orother physical location ofthe facility (e.g. Acme Road or Building 3, XYZ Industrial Park) together with telephone and facsimile numbers. Provide a briefdescription ofthe nature ofthe business conducted by the facility. Provide name ofthe Indian Reservation onwhich the facility is located. Provide name and contact information for the facility contact person responsible for source compliance with this rule. OWNERand OPERATOR Enter the name ofthe owner and operator ofthe facility for which this application is being prepared. For individual owners, list the full name (last, middle initial, first). Formultiple ownership where no legal business partnership exists, provide the name and mailing address, ifdifferent, ofeach individual owner using a backslash (\) to separate data for each owner. For corporations, include divisions or subsidiary name, ifany. Enter the complete mailing address ofthe owner and operator. Provide name and contact information for the contact person authorized to receive requests for data and information. PROCEDURE FOR ESTIMATING EMISSIONS The initial registration and annual registration must include an estimate ofactual emissions taking into account equipment, operating conditions, and airpollution control measures. Foran existing airpollution source that operated during the calendar year preceding the initial registration or annual registration submittal, the actual emissions are the actual rate ofemissions for the preceding calendar year and must be calculated using the actual operating hours, production rates, in-place control equipment, and types ofmaterials processed, stored, or combusted during the preceding calendar year. For a new air pollution source that is submitting its initial registration, the actual emissions are the estimated actual rate ofemissions for the current calendar year. The emission estimates must be based upon actual test data or, in the absence ofsuch data, upon procedures acceptable to the Regional Administrator. Any emission estimates submitted to the Regional Administrator must be verifiable using currently accepted engineering criteria. 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; (iv) Otherengineering calculations; or (v) Other procedures to estimate emissions specifically approved by the Regional Administrator.

EPA Form 7630-4 Page 6 of6

### --------------------

--------------- Fonn Approved OMB 2060-0558 Approval Expires 5131/2011 

### UNITED STATES ENVIRONMENTAL PROTECTIONAGENCY 

# oEM REGION 10 FEDERAL AIR RULES FORINDIAN RESERVATIONS REPORT OF RELOCATION Applicability: Airpollution sources regulated by 40 Code ofFederal Regulations Part 49.138. INSTRUCTIONS: For any source relocation afterinitial registration, the owner oroperatorofan air pollution source must submit a reportofrelocation in writing no laterthan 30 days priorto relocation ofthe source. A. GENERAL INFORMATION 1. Identifying Information Source (Facility) Air Quality Operating Permit No. (ifapplicable)

________________ Nature ofthe Telephone <---)

______ 

### Facsimile '-_-'

_______ New Source Physical Address: Street

__________________ City

_________ County

______State

___ ZIP

________ Previous Physical Address: Street

___________________ City

_________ County
______ State

___ ZIP

_______ Indian Reservation Name Compliance Contact Person

__________ (Local Person responsible for source compliance with this rule) 

### Telephone '-_-'
________Ext.

____ Facsimile <---).

_______ 

### Contact Person Mailing Address: Street (or PO Box #)

_______________



### __________County
_____State

____ ZIP

________ 

### e.mail address

EPA Form 7630-7 Page 10f6

## -----------------

---------------

------------------- Form Approved OMS 2060-0558 Approval Expires 5/31/20II 

### A. GENERAL INFORMATION Cont.

Owner's Telephone '-_-'

________ Ext.

____ Facsimile

_______ OwnerMailing Address: Street (orPO Box #)

______________

_ . ________ County

_______State

___ ZIP

________ e.mail address 

### Contact

__________ (Person authorized to receive requests for data and information) Telephone {\ '-----J
___ ____Ext.

_____Facsimile '-

__/

__________ Contact Mailing Address: Street (or PO Box#)

_________________________

_________--:-____County

_______.State
_____ZIP

__________ e.mail address

_______________ 

### Operator's Name

_________________

## CIfdifferent from owner) Telephone**(~** ________Ext.

____ Facsimile '--_-'

_______ Operator's Mailing Address: Street CorPO Box#)

______________

_________ County

_______State

___ ZIP

________ e.mail address

_______________________ 

### Contact (Person authorized to receive requests for data and information) Telephone '--

__, _________Ext.
_____Facsimile '-_---'

________ Contact Mailing Address: Street (or PO Box#)

__...________________

__________ County

_______State
_____ZIP

__________ e.mail address


### 2. Effective Date of SourceRelocation. Date / /

EPA Form 7630·7 Page 2 of6Form Approved OMB 2060-0558 Approval Expires 5/31120))


### B. REPORT OF RELOCATION

1. Provide:A written description of relocation activities. Update any of the information listedbelowthatwill change as a result of the relocation. 

# o Process flow chart identifYing all processing, combustion, handling, storage, and emission control equipment 

# o Narrative description ofthe production processes and airpollution control equipment 

# o List ofall emission units and airpollution generating activities; include model and serial numbers for portable equipment 

# o Plot Plan V' Location ofall emissionunits and airpollution generating activities V' Property lines for the air pollution source V' Elevation above grade for each emission release point V' Distance and direction to nearest residential or commercialproperty. 

# o Type and quantity offuels, including sulfur content offuels, used on a daily, annual and maximumhourly basis 

# o Type and quantity ofraw materials used orfinal product produced on a daily, annual and maximumhourly basis 

# o Typical operating schedule, including number ofhours perday, number ofdays per week and number ofweeks per year 

# o List ofestimated efficiency ofairpollution control equipmentunder present or anticipated operating conditions 

# o Estimates ofthe total actual emissions from the air pollution source for the following air pollutants: particulate matter, PMIO, PM2.5, sulfur oxides (SOx), nitrogen oxides (NOx), carbon monoxide (CO), volatile organic compound (VOC), lead (Pb) andlead compounds, ammonia (NH3), fluorides (gaseous and particulate), sulfuric acid mist (H2S04), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds, including allcalculations for the estimates 

# o Other (provide details). 

### Confidential Treatment ofInformation. You may assert a business confidentiality claim covering any portion ofthe submitted information as provided in 40 C.F.R. part 2, subpart B. Please submit any information you claim as confidentialbusiness information separately, along with your claim ofconfidentiality. Note that emissions data and information necessary to determine emissions is not entitled to confidential treatment. Failure to assert a claim in the manner described in 40 C.F.R. part 2, subpart B allows the submitted information to be released to the public without further notice. Information subject to a business confidentiality claim may be disclosed by EPA only to the extent set forth in the above-cited regulations.

EPA Fonn 7630-7 Page 3 of6Fonn Approved OMB 2060-0558 Approval Expires 5/3112011



### B. ATTACHMENTS 2. TABLE OFANNUAL EMISSIONS. Update ifemissions will change as a result ofrelocation. 

### The following table shouldbe completedby inserting estimates ofthe total actual emissions in tons/year for all pollutants contained in your worksheet stated above.

Pollutant Total Emissions

PM10 

### PM2.5 I 

### SOx NOx CO VOC Pb NH3 Fluorides H2SO4 IDS TRS 

### Definition of acronyms. PM 10 

### Particulate Matter PM2.5 Particulate Matter SOx Sulfur Oxides NOx Nitrogen Oxides CO Carbon Monoxide VOC Volatile Organic Compound Pb Lead and lead compounds NH3 Ammonia Fluorides Gaseous and particulates H2S04 Sulfuric AcidMist H2S Hydrogen Sulfide TRS Total Reduced Sulfur andreduced sulfur compounds.

EPA Fonn 7630-7 Page 4 of6

## ------------------ Form Approved OMB 2060-0558 Approval Expires 5/3) 120I ) 

### C. 

### OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND COMPLETENESS 1. Certifying Official Information: Identify the certifying official and provide contact information. Name: (Last)

________(First)

__......_____(Middle)

_____
Street or P.O.

__..__________________________ City

__________County

_______State

_____--'ZIP

____ Telephone L-)

__- Ext.

___ Facsimile '--_,

________ e.mail address

2. Certification ofTruth, Accuracy and Completeness: The Certifying Official must sign this statement afterthe form is completed for each applicable requirement. I certify that, based on information and beliefformed after reasonable inquiry, the statements and information contained in these documents are true, accurate and complete.

Name (printed ortypedL

________________Date

__I

__I
__ e.mail address

Return completed forms and attachments to: EPA Region 10 (OAWT-I07) FARR Registration Coordinator Office ofAir Waste and Toxics 1200 Sixth Avenue Seattle, W A 98101
The public reporting and recordkeeping burden for this collection ofinformation is estimated at 5.61 hours on average. Send comments onthe Agency's need for this information, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use ofautomated collection techniques to the Director, Collection Strategies Division, US Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number 2060-0558 in any correspondence. Do not send the completed form to this address.

EPA Form 7630·7 Page 5 of6Form Approved OMB 2060-0558 Approval Expires 5/31/20II


### FARRREGISTRATION APPLICATION INSTRUCTIONS. GENERAL INFORMATION. IdentifYingInformation. 

### FACILITY. Enterthe name and the new street address orotherphysical location ofthe facility ( e.g. Acme Road orBuilding 3, XYZ Industrial Park) together with telephone and facsimile numbers. Provide a briefdescription ofthe nature ofthe business conducted by the facility. Provide name ofthe Indian Reservation on which the facility is located. Provide name and contact information for the facility contact person responsible for source compliance with this rule. 

### OWNERAND OPERATOR. Enter the name ofthe owner and operator ofthe facility for which this application is being prepared. For individual owners, list the full name (last, middle initial, first). Formultiple ownership, where no legal business partnership exists, provide the name and mailing address, ifdifferent, ofeach individual owner using a backslash (\) to separate data for each owner. Forcorporations, include divisions or subsidiary name, ifany. Enter the complete mailing address ofthe owner. Provide name and contact information for the contactperson authorized to receive requests for data and information. 

### PROCEDURE FOR ESTIMATING EMISSIONS. The initial registration and annual registration must include an estimate ofactual emissions taking into account equipment, operating conditions, and airpollution control measures. For an existing airpollution source that operated during the calendar yearpreceding the initial registration orannual registration submittal, the actual emissions are the actual rate ofemissions for the preceding calendar year and must be calculated using the actual operating hours, production rates, in-place control equipment, and types ofmaterials processed, stored, or combusted during the preceding calendaryear. Fora new airpollution source that is submitting its initial registration, the actual emissions are the estimated actual rate ofemissions for the current calendar year. The emission estimates must be based upon actual test data or, in the absence ofsuch data, upon procedures acceptable to the Regional Administrator. Any emission estimates submitted to the Regional Administrator must be verifiable using currently accepted engineering criteria. The following procedures are generally acceptable for estimating emissions from airpollution sources: (i) Source-specific emission tests; (ii) Mass balance calculations; (iii) Published, verifiable emission factors that are applicable to the source; (iv Other engineering calculations; or (v) Otherprocedures to estimate emissions specifically approved by the Regional Administrator.

EPA Form 7630-7 Page 6 of6------- 

### ----- ----

-------------- ----------------

----------------------- Form Approved OMB 2060-0558 Approval Expires 5/3 )/20) I 

### UNITED STATES ENVIRONMENTAL PROTECTION AGENCY 

# oEPA REGION 

## to FEDERAL AIR RULES FOR INDIAN RESERVATIONS 

### REPORT 

### OF CLOSURE ility: Airpollution sources regulated by40 Code ofFederal Regulations Part 49.138. INSTRUCTIONS: Except for regular seasonal closures, afterinitial registration, the owner or operatorofan airpollution source must suhmit a reportofclosure in writing within 90 days after cessation ofall operations.


### A. GENERAL INFORMATION

1. Identifying Information Source (Facility) Effective Date ofthe Source Closure

__1

__1

____ 

### Air Quality Operating PermitNo. (ifapplicable)_**Narureofilie~~O'U~OQ'** 

### __________________________ Telephone

_______ Facsimile

_______ Source Physical Address: Street

__________________ State ZIP Indian Reservation Compliance Contact Title (Local Person responsible for source compliance with this rule) 

### Telephone '--_-'
________Ext.
______Facsimile

# <--)

______ _ Contact Person Mailing Address: Street (or PO Box #)

__________________



### ________-State ZIP

________ 

### e.mail address

EPA Form 7630-6 Page 1 of5------- ---- ----- ----



### -----------------

----------

----- 

### ----

---------------



# -------------- Fonn Approved OMB 2060-0558 Approval Expires 5/31/2011 

### A. GENERAL INFORMATION Cont. Owner's Telephone '--_j

________ Ext.
____Facsimile 

## L.--J

_______ Owner's Mailing Address: Street (or PO Box #) State ZIP

,----'---­ e.mail address Contact (person authorized to receive requests for data and information) Telephone Ext. '----' ---- ---­ Facsimile Contact Mailing Address: Street (or PO Box #)

__________________ City

________County
_________State

___ ZIP

________ e.mail address Operator's Name,

________________(,Ifdifferent from owner) Telephone '--_-'
________Ext.

____ Facsimile '--_-'

____ Operator'sMailing Address: Street (orPO Box #) City County
________ State

____ ZIP

________ e.mail address Contact

_______________ (Person authorized to receive requests for data a.nd information) Telephone '--_-'
________Ext.

____ Facsimile**(~** _______ Contact Mailing Address: Street (or PO Box #)

__________________

- ••..J
___________ State

____ ZIP

________ e.mail address

________________

EPA Form 7630-6 Page 2 of5Fonn Approved OMB 2060-0558 Approval Expires 5/31120IJ 

### B. REPORT OF CLOSURE. 1. Provide: A written description of closure activities and/orcare andmaintenance activitiesperformedat thesource anda statementdescribing the duration of the source closure. (e.g. temporary vs.permanent).



### Confidential TreatmentofInformation. You may assert a business confidentiality claim covering any portion ofthe submitted information as provided in 40 C.F.R. part 2, subpart B. Please submit any information you claim as confidential business information separately, along with your claim ofconfidentiality. Note that emissions data and information necessary to determine emissions is not entitled to confidential treatment Failure to assert a claim in the manner described in40 C.F.R. part 2, subpart B allows the submitted information to be released to the public without further notice. Information subject to a business confidentiality claimmaybe disclosed by EPA only to the extent set forth in the above-cited regulations.

EPA Fonn 7630-6 Page 3 of5

### ----------------------------------------------------------- Form Approved OMB 2060-0558 Approval Expires 5/31/20II 

### C. 

### OWNER OROPERATOR CERTIFICATION OF TRUTH, ACCURACY AND COMPLETENESS

1. Certifying Official Information: Identify the certifying official andprovide contactinfonnation. Name: (Last),

________(First)

_______(,Middle)

_____ Title Street or P.O. City

_________ County

_____________,State

_________ZIP

___________ Telephone 

### {->

__-

____ Ext.
_____Facsimile 

### {->

___________ 2. Certification ofTruth, Accuracy and Completeness: The Certifying Official must sign this statement after the fonn is completed for each applicable requirement. I certify that, based on infonnation and belieffonned after reasonable inquiry, the statements and infonnation contained in these documents are true, accurate and complete. Name (signed)

________________________ Narne (printed or

Return completed forms and attachments to: EPA Region 10 (OAWT) FARR Registration Coordinator Office ofAir Waste and Toxics 1200 Sixth Avenue Seattle, W A 98101

The public reporting and recordkeeping burden for this collection ofinfonnation is estimated at 5.61 hours on average. Send comments onthe Agency'sneed for this infonnation, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden, including through theuse ofautomated collection techniques to the Director, Collection Strategies Division, US Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number 2060-0558 in any correspondence. Do not send the completed fonn to this address.

EPA Form 7630-6 Page 4 of5Form Approved OMB 2060..(J558 Approval Expires 5/31/2011


### FARRREGISTRATION APPLICATION INSTRUCTIONS. GENERAL INFORMATION. IdentifyingInformation. 

### FACILITY. Enter the name and the correct street addressor otherphysical location of the facility ( e.g. Acme Road or Building 3, XYZ Industrial Park) together with telephone and facsimile numbers. Provide a briefdescription ofthe nature ofthe business conductedby the facility. Provide name ofthe Indian Reservation on which the facility is located. Provide name and contact information for the facility contact person responsible for source compliance with this rule. 

### OWNER AND OPERATOR. Enter the name ofthe owner and operator ofthe facility for which this application is beingprepared. For individual owners, list the full name (last, middle initial, first). Formultiple ownership, where no legal business partnership exists, provide the name and mailing address, ifdifferent, ofeach individual owner using a backslash (\) to separate data for each owner. Forcorporations, include divisions or subsidiary name, ifany. Enter the complete mailing address ofthe owner and operator. Provide name and contact information for the contact person authorized to receive requests for data and information. 

### PROCEDURE FOR ESTIMATING EMISSIONS. The initial registration and annual registration must include an estimate ofactual emissions taking into account equipment, operating conditions, and airpollution control measures. For an existing airpollution source that operated during the calendar yearpreceding the initial registration or annual registration submittal, the actual emissions are the actual rate ofemissions for the preceding calendar year and must be calculated using the actual operating hours, production rates, in-place control equipment, and types ofmaterials processed, stored, or combusted during the preceding calendar year. For a new air pollution source that is submitting its initial registration, the actual emissions are the estimated actual rate ofemissions for the current calendar year. The emission estimates must be based upon actual test data or, in the absence ofsuch data, upon procedures acceptable to the Regional Administrator. Any emission estimates submitted to the Regional Administratormustbe verifiable using currently accepted engineering criteria. The following procedures are generally acceptable for estimating emissions from airpollution sources: (i) Source-specific emission tests; (ii) Mass balance calculations; (iii) Published, verifiable emission factors that are applicable to the source; (iv) Other engineering calculations; or (v) Otherprocedures to estimate emissions specifically approved by the Regional Administrator.

EPA Form 7630-6 Page 5 of5

## -------------- Form Approved OMS 2060-0558 Approval Expires 5/31/2011

i 

### UNITED STATES ENVIRONMENTAL PROTECTION AGENCY 

# &e'A REGION 10 FEDERAL AIR RULES FORINDIAN RESERVATIONS REPORT OF CHANGE OF OWNERSHIP Applicability: Airpollution sources regulated by 40 Code ofFederal Regulations Part 49.138. Reportchange ofownership within 90 days after the effective date ofchange. INSTRUCTIONS: Complete applicable parts ofSections A, B, C and D.
A. GENERAL INFORMATION

Identifying Information Previous Source (Facility) Previous Owner's Name

________________________ New Source (Facility) Name

_______________________ Air Quality Operating Pennit No. (ifapplicable)

________________ Nature ofthe Business.

_________________________ Telephone 

### <--:)

______ Facsimile '--_-'

_______ Source Physical Address: Street

__________________ City

__________ County
_______State

____ ZIP

________ Indian Reservation Compliance ContactPerson

_____________ (Local Person responsible for source compliance with this rule) 

### Telephone 

### <--:)
_______Ext.

____ Facsimile 

### <--:)

_______ Contact Person Mailing Address: Street (or PO Box#)

_______________



### __________ County

______ State

____ ZIP

________ 

### e.mail address

EPA Form 7630-5 Pagelof6

## -----------------

--------- Form Approved OMS 2060-0558 Approval Expires 5/31/2011 

### A. GENERAL INFORMATION Cont. Owner's New Telephone 

## L--->

_______ Ext.

____ Facsimile 

## L--->

_______ Owner Mailing Address: Street (orPO Box #)

______________

______. ____County

_______ State
____ZIP

_________ e.mail address

______________ Contact

_________ (Person authorized to receive requests for data and information) Telephone 

## L--->

_______ Ext.

____ Facsimile 

## L--->

_______ Contact Person Mailing Address: Street (or PO Box #)

_________________

_____...______County
________State

____ ZIP

_________ e.mail address Operator's Name

_______________________(Ifdifferent from owner) New Telephone 

## L--->

_______ Ext.
_____Facsimile '-_-'

________ Operator Mailing Address: Street (or PO Box#)

______________

__________County
________ State
____ZIP

________ e.mail address Contact

__________ (Person authorized to receive requests for data and information) Telephone '--_-'
________Ext.
_____Facsimile '--_--'

________ Contact Person Mailing Address: Street (or PO Box#)

__________________

__.....________County
________ State

____ ZIP

________ e.mail address



### -------­
Effective Date ofChange ofOwnership

EPA Form 7630-5 Page 2 of6Form Approved OMB 2060-0558 Approval Expires 5/3112011 

### B. ATTACHMENTS

Include any ofthe following information as attachments to this form that requires updating as a result ofthe change ofownership [J Process flow chart identifying all processing, combustion, handling, storage, and emission control equipment [J Narrative description ofthe production processes and air pollution control equipment [J List ofall emission units and air pollution generating activities; include model and serial numbers for portable equipment [J Plot Plan ,/' Location ofall emissionunits and airpollution generating activities ,/' Property lines for the airpollution source ,/' Elevation above grade for each emission release point ,/' Distance and direction to nearest residential or commercial property [J Type and quantity offuels, including sulfur content offuels, used on a daily, annual and maximum hourly basis [J Type and quantity ofrawmaterials used or final product produced on a daily, annual and maximumhourly basis [J Typical operating schedule, including number ofhours perday, number ofdays per week and number ofweeks per year [J List ofestimated efficiency ofairpollution control equipment under present or anticipated operating conditions [J Estimates ofthe total actual emissions from the air pollution source for the following air pollutants: particulate matter, PMIO, PM2.5, sulfur oxides (SOx), nitrogen oxides (NOx), carbon monoxide (CO), volatile organic compound (YOC), lead (Pb) and lead compounds, ammonia (NH3), fluorides (gaseous and particulate), sulfuric acid mist (H2S04), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds, including all calculations for the estimates [J Other (provide details) 

### Confidential TreatmentofInformation You may assert a business confidentiality claim covering any portion ofthe submitted information as provided in 40 C,F.R. part 2, subpart

### B. Please submit any information you claim as confidential business information separately, along with your claim ofconfidentiality. Note that emissions data and information necessary to determine emissions is not entitled to confidential treatment. Failure to assert a claim inthe manner described in 40 C.F.R. part 2, subpart B allows the submitted information to be released to the public without further notice. Information subject to a business confidentiality claim maybe disclosed by EPA only to the extent set forth in the above-cited regulations

EPA Form 7630-5 Page 3 of6Form Approved OMB 2060-0558 Approval Expires 5/31/2011


### C. TABLE OF ANNUAL EMISSIONS 

### The following table should be completedby inserting estimates ofthe total actual emissions in tons/year for all pollutants contained inyour worksheet stated above.

Pollutant 

## I Total 

## I

. Emissions 

### .PM

PM 10 

### PM 2.5 SOx NOx I 

### .CO

VOC i 

### Pb

NH3 Fluorides H2SO4 H2S TRS RSCL

### Definition of acronyms PM 

### PM10 PM2.5 SOx NOx CO VOC Pb NH3 Fluorides H2S04 H2S TRS RSC Particulate Matter Particulate Matter less than 10 

### microns in size Particulate Matter less than 

### 2.5 microns in size Sulfur Oxides Nitrogen Oxides Carbon Monoxide Volatile Organic Compound Lead and lead compounds Ammonia Gaseous and particulates Sulfuric Acid Mist Hydrogen Sulfide Total Reduced Sulfur Reduced Sulfur Compounds

EPA Form 7630-5 Pagc4of6

# ----------------------- Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

### D. OWNER OR OPERATOR'S CERTIFICATION OF TRUTH, ACCURACY AND COMPLETENESS Certifying Official Information: Identify the certifying official and provide contact information. Name: (Last)

________(First),

_______(Middle)

_____
Street or P.O. City

_________County

_______State

_____----'ZIP

_________ Telephone '---'

______ Ext.
___Facsimile e.mail address

Certification ofTruth, Accuracy and Completeness: The Certifying Official must sign this statement after the form is completed. I certify that, based on information and beliefformed after reasonable inquiry, the statements and information contained in these documents are true, accurate and complete. Name (signed)

_______________________ Name (printed or

Return completed forms and attachments to: EPA Region 10 (OA WT) FARR Registration Coordinator Office ofAirWaste and Toxics 1200 Sixth Avenue Seattle, WA 98101

Thepublic reporting and recordkeeping burden for this collection ofinformation is estimated at 5.61 hours on average. Send comments on the Agency's need for this information, the accuracy ofthe provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use ofautomated collection techniques to the Director, Collection i Strategies Division, US Environmental Protection Agency (2822T), 1200 Pennsylvania Ave.,

. NW, Washington, D.C. 20460. Include the OMB control number 2060-0558 in any

, correspondence. Do not send the completed form to this address.

EPA Form 7630-5 Page 5of6Form Approved OMS 2060-0558 Approval Expires 5/31/2011
FARRREGISTRATION APPLICATION INSTRUCTIONS GENERAL INFORMATION IdentifyingInformation FACILITY Enterthe name and the correct street address orother physical location ofthe facility (e.g. Acme Road or Building 3, XYZ Industrial Park) together with telephone and facsimile numbers. Provide a briefdescription ofthe nature ofthe business conducted by the facility. Provide name ofthe Indian Reservation onwhich the facility is located. Provide name and contact information for the facility contact person responsible for source compliance with this rule. OWNER 

### IOPERATOR Enter the name ofthe new owner and operator ofthe facility for which this application is being prepared. For individual owners, list the full name (last, middle initial, first). Formultiple ownership where no legal business partnership exists, provide the name and mailing address, ifdifferent, ofeach individual owner using a backslash (\) to separate data for each owner. For corporations, include divisions or subsidiary name, ifany. Enterthe complete mailing address ofthe new owner and operator. Provide name and contact information for the contact person authorized to receive requests for data and information. PROCEDURE FOR ESTIMATING EMISSIONS The initial registration and annual registration must include an estimate ofactual emissions taking into account equipment, operating conditions, and air pollution control measures. For an existing airpollution source that operated during the calendar year preceding the initial registration or annual registration submittal, the actual emissions are the actual rate ofemissions for the preceding calendaryear and must be calculatedusing the actual operating hours, production rates, in-place control equipment, and types ofmaterials processed, stored, or combustedduring the preceding calendar year. For a new air pollution source that is submitting its initial registration, the actual emissions are the estimated actual rate ofemissions for the current calendar year. The emission estimates must be based upon actual test data or, in the absence ofsuch data, upon procedures acceptable to the Regional Administrator. Any emission estimates submitted to the Regional Administrator must beverifiable using currently accepted engineering criteria. 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; (iv) Otherengineering calculations; or (v) Otherprocedures to estimate emissions specifically approved by the Regional Administrator.

EPA Form 7630-5 Page 60f6Fonn Approved OMB 2060-0558 Approval Expires 5!3l1201l 

### U.S. Environmental Protection Agency 

# &EPA Region 10 FederalAir Rules for Reservations, 40 CFR49.139 

# Non-Title V Operating PermitApplication Form Instructions 1. 

### Assistance on Non-Title V OperatingPermits Any airpollution source (facility) wishing to request federally-enforceable limitations on their actual emissions orpotential to emit should become familiar with the Region 10 Federal Air Rules for Reservations (FARR), the application form, and these instructions. The FARR was originally published in the Federal Registeron April 8, 2005 (67 FR 18074) and is effective June 7,2005. The final rule is available at the EPA Region 10 website www.epa.govlregionJO/farr. The FARR rule can also be found in the annually updated Code ofFederal Regulations (CFR) Title 40, Part 49. The non-Title V operating permit requirements can be found in 40 CFR49.139. The FARR website provides additional background information on the rule and implementation ofthe FARR. The FARR Hotline is available at 1-800-424-4EPA to provide information, permit forms and respond to questions. Additional guidance pertaining to air quality regulations and programs can also be found on line at EPA's national website at www.epa.gov/oar. 

### 2. Who Can Request Federally-Enforceable Limitations Under the FARRAuthority? The FARR applies only to sources located within the exterior boundaries ofan Indianreservation in Idaho, Oregon and Washington or otherreservation lands as specified in40 CFRpart 49, subpart M. So, to use the authority in the FARR to create federally-enforceable limitations, a facility must be located within a reservation in one ofthose states. Land ownership status (for example, whether the land is ownedby a Tribal member or whether the land is owned in fee or in trust) does not affect how the rule applies. 

### 3. Who Might Want to Request Federally-Enforceable Limitations? The primary reason for requesting federally-enforceable limitations is to avoid an otherwise applicable federal Clean Air Actprogram, rule or requirement. Many federal Clean Air Act programs use a source's "potential to emit" (PTE) air pollution to determine which rules or requirements apply. A facility's PTE is based on the maximum annual operational (production, throughput, etc) rate ofthe facility taking into consideration the capacity and configuration ofthe equipment and operations. Emission or operational limits can also be taken into consideration as maximums ifthey are federally enforceable. So, using a non-Title V operating permit to establish federally enforceable limitations can lower a facility's PTE and possibly allow the facility to avoid certain federal Clean Air Act requirements. Three examples offederal Clean Air Act programs that use PTE to determine whether they apply are (1) the Prevention ofSignificant Deterioration (PSD) construction permitting program, (2) the Title V operating permitprogram, and (3) the Maximum Achievable 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 for a Title V operating permit. Ifa source accepts a federally-enforceable limitation through a non-Title V permit that reduces their PTE to below the "major" threshold, the source no longer needs a Title V operating permit. Whenplanning for the construction ofa new source or expansion ofan existing source, a source can also accept limitations on PTE (using a non-Title V

EPA Fonn 7630-9 Page 1of4Fonn Approved OMB 2060-0558 Approval Expires 5/31/2011 pennit) 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. 4. Where to Submit the Non-Title V Operating Permit Application Form Send completed fonns and all applicable attachments and supporting infonnation, as specified in the fonn, to: Non-Title V Operating Pennit Coordinator U.S. EPA, Region 10 AWT-I07 1200 Sixth Avenue Seattle, WA 98101 5. Confidential Treatment ofInformation A company may assert a business confidentiality claim covering any portion ofthe submitted infonnation as provided in 40 CFRpart 2, subpart B. Please submit any infonnation claimed as confidential business infonnation separately, along with a claim ofconfidentiality. Note that emissions data and infonnation necessary to detennine emissions is not entitled to confidential treatment. Failure to assert a claim in the manner described in 40 CFRpart 2, subpart B allows the submitted infonnation to be released to the public without further notice. Infonnation subject to a business confidentiality claim may be disclosed by EPA only to the extent set forth in the above-cited regulations. 6. Instructions for Each Section ofApplication Form There are three individual sections ofthe fonn which specify the required infonnation as well as the additional infonnation that must be attached to the fonn. The entire fonn mustbe completed, including the certification oftruth, accuracy and completeness in Section D. Instructions for each section follow. Section A General Infonnation General facility infonnation is required to be submitted each request for a federally-enforceable limitation. This section allows the source to identify the location, contacts and other general infonnation about the source. The facility's main nature ofbusiness generally describes the products that the facility manufactures or the services it provides. Standard Industrial Classification (SIC) codes are commonly used for state revenue reporting and can be found in a document called SIC manual or on line at http://www.osha.gov/pls/imis/sic_manual.html. Most libraries have the SIC manual available for public use. Ifthe source does not have a street address, a briefdescription ofthe physical location ofthe source should be included. The local individual responsible for compliance is commonly a person with the authority to make operations and purchasing decisions that assure compliance, such as a plant manager. Section B Limitation Request This section lists the infonnation that must be attached to the application form for each requested limitation. The requested limitation(s) must be described for each affected emissions unit (or pollutant-generating activity) and pollutant and must be accompanied by the supporting infonnation listed on the fonn and described below. Note that applicability ofmany federal Clean Air Act requirements (such as Title V, PSD and MACT) is often based on facility-wide

EPA Fonn 7630-9 Page 2 of4Fonn Approved OMB 2060·0558 Approval Expires 5/3112011 emission levels ofspecific pollutants. In that case, all emissions units at a facility and all pollutants regulated by that given rule or regulation must be addressed by this section ofthe application form. Item I The requested limitation and its effect on actual emissions orpotential to emit must be presented in enough detail to document how the limitation will limit the source's actual or potential emissions as a legal and practical matter and, ifapplicable, will allow the source to avoid an otherwise applicable requirement. The information presented must clearly explain how the limitation affects each emission unit (see Item 4) and each airpollutant from that emission unit Use the information provided in response to Items 7 and 8 below to explain how the limitation affects emissions before and afterthe limitation is in effect Item 2 - Foreach requested limitation, the application must include proposed testing, monitoring, recordkeeping and reporting that will be used to demonstrate and assure compliance with the limitation. Testing approaches should incorporate and reference appropriate EPA reference methods where applicable. Monitoring should describe the emission, control orprocess parameters that will be relied onand should address frequency, methods, and quality assurance. Item 3 - A narrative description ofall ofthe facility processes along with a process flow diagram must be provided to enable EPA to understand the effect the limitation(s) will have on the operation. A process flow diagram must also be provided which reflects the majorpieces of equipment that combust, process, handle orstore materials orproducts. The narrative description should follow the flow ofthe process flow diagram and address all ofthe major processing and storage equipment, control devices (see Item 6), products, fuels and raw materials (see item 5). The hourly, daily and annual (maximum for each) operating rates for each productionprocess or device and the hourly, daily and annual maximum firing rates for each fuel and combustion equipment should be described. The capacity for storage units and the material and product handling equipment should be listed. The typical operating schedule should be presented in terms ofhours perday, days perweek, and weeks peryear. Item 4

- The application must include a list ofemissionunits and airpollution-generating activities that will be affected by the requested limitation. Each listed emission unit should be addressed byItems I through 8 to the extent applicable. Item 5 The application must include a list ofthe type and quantity offuels andior raw materials used. Each fuel and raw material should be consistently addressed by the Items 3, 7 and 8, and, if the limitation involves fuels orraw materials, Items I and 2. Item 6 The application must include a description and estimated efficiency ofairpollution control equipment underpresent oranticipated 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. improved efficiency) ornewly installed to meet the proposed limit, address both current and future descriptions and efficiencies. Items 7 and 8

- Air pollutant emission estimates must be provided for the current actual and potential emissions as well as the future potential (allowable) emissions, including all ofthe supporting calculations, assumptions and references. Emission estimates must address all emission units (see Item 4) and pollutants affected by the limitation and bepresented in short term (e.g. pounds perhour) as well as annual (tons peryear) units. Actual emissions reflect the operations and controls in place during a past period oftime (e.g., most previous past calendar year), while potential to emit and allowable emissions are based on maximum short term operating rates scaled to an entire year. Estimates offuture emissions should reflect maximum

EPA Fonn 7630-9 Page 3 of4Form Approved OMB 2060-0558 Approval Expires 5/3112011 allowable operating rates and anticipated controls. All ofthe data and calculations used to develop the emission inventory must be attached to and submitted with the application form. All assumptions that were made, such as pollutant emitted, control efficiencies and emissions factors used, shouldbe clearly documented with the calculations. References for each emission factor and any otherresources used for developing the emission inventory should also be includedwith the emission estimates. Emission estimation tools and techniques can be found on line at http://www.epa.gov/ttn/chief: Estimates ofactual emissions must be based upon actual test data, or in the absence ofsuch data, uponprocedures acceptable to the Regional Administrator. Any emission estimates submitted to the Regional Administratormust be verifiable using currently accepted engineering criteria
..Be aware that the resulting non-Title V permit will likely require verification ofcompliance with the requested limitation; so reliable emission estimation techniques are important. The following procedures are generally acceptable for estimating emissions from airpollution sources: • Source-specific emission tests; • Mass balance calculations; • Published, verifiable emission factors that are applicable to the source; • Other engineering calculations; or • Other procedures to estimate emissions specifically approved by the Regional Administrator. Section C Certification ofTruth, Accuracy and Completeness The owner or operator ofthe facility must certify the truth, accuracy and completeness ofthe statements and information in and attached to the application form. The application must be signed and dated prior to submittal. Ifthere is more than one owner, list the other owners on an attachment. For example, the owner(s) couldbe an individual, a partnership, a company, a parent company, orany combination ofthese.

EPA Form 7630-9 Page 40f4Form Approved OMB 2060-0558 Approval Expires 5/3112011 

### U. S. Environmental Protection Agency 

# &EPA Region 10 Federal Air Rules for Reservations, 40 CFR 49.139 

## Non-Title V Operating Permit Application Form Request for Federally-Enforceable Limitation Complete all sections ofthis fonn. Foradditional guidance, see the Non-Title V Operating Pennit Application Fonn Instructions. Electronic copies offonns and guidance can be found at www.epa.gov/regionl0/farr Mail completed application fonns to: Non-Title V Operating Pennit Coordinator U.S. EPA, Region 10 AWT-I07 1200 Sixth Avenue Seattle, WA 98101
A. Generallnformation 1. Name ofAir Pollution Source:

_______________________________ Nature ofthe Business:

________________ Primary SIC Code:

_______ Other SIC Codes:

_________________ StreetAddress:

____________________________________ Telephone Number:

_____________ Source Facsimile Number:

_______________ 2. Local Individual Responsible for Compliance Name:

________________________ Mailing Address:

____________________________________ Telephone Number:

______________ Facsimile Number:

______________ 3. Individual Authorized to Receive Requests for Data & Infonnation Name:

________________ Mailing Address:

__________________________________ 4. OwnerName:

______________________________________ Mailing Address:

__________________________________ TelephoneNumber: 5. Ope rator Name (ifdifferent from Owner): Mailing Address:

_____________________________________ TelephoneNumber:

__________________________________

EPA Form 7630-9 Page 1 of2Form Approved OMB 2060-0558 Approval Expires 5/31/2011

B. Limitation Request Foreach air pollutant and for all emissions units and air pollutant-generating activities to be covered by a limitation, attach the following: 1. The proposed limitation and a description ofits effect on actual emissions or the potential to emit. 2. The proposedtesting, monitoring, recordkeeping and reporting requirements to be used to demonstrate and assure compliance with the proposed limitation. 3. A description ofthe production processes and a related process flow chart. 4. A list ofemission units and airpollution-generating activities. 5. The type and quantity offuels and/or raw materials used. 6. A description and estimated efficiency ofair pollution control equipment underpresent oranticipated operating conditions. 7. Estimates ofthe current actual emissions and current potential to emit, including all calculations for the estimates. 8. Estimates ofthe allowable emissions and/orpotential to emit that would result from compliance with the proposed limitation, including all calculations for the estimates.

C. Certification ofTruth, Accuracy and Completeness The Owner or Operator (listed above) must sign this statement before submittal ofthis application form. I certify that, based on information and beliefformed after reasonable inquiry, the statements and information in and attached to this form are true, accurate and complete. Owner orOperator (circle one) Name:

Owner or Operator Signature:

_____ Date:

The public reporting and recordkeeping burden for this collection ofinformation is estimated at 88.33 hours perresponse on average. Send comments on the Agency's need for this information, the accuracy of the providedburden estimates, and any suggested methods for minimizing respondentburden, including through the use ofautomated collection techniques to the Director, Collection Strategies Division, US Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number 2060-0558 in any correspondence. Do not sendthe completed form to this address.

EPA Form 7630-9 Page 2 of2