FARR Forms Attached: 

Burn Permit 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 and Forms for Initial! Annual Source Registration, Report of 

Relocation, Report of Closure, and Report of Change of Ownership 

40 CFR 49.138 Rule for the registration of air pollution sources and the reporting 

ofemissions 

Instructions and Form for Non-Tide V Operating Permit 

40 CFR 49.139 Rule for non-Title V operating pennits 

Form 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 6 feet in diameter or more than 30 feet ofditch bank or fence line ve~etation. 

Agricultural, forestry-related, and small 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 large 

open burning within the exterior boundaries ofthe 1863 Nez Perce Reservation. After sending in the Air Quality 

Permit Application (pages 3-4) and receiving approval to burn, THIS SIGNED SHEET IS YOUR PERMIT (pages 

1-2). Keep it available andprovide it upon request to the Nez Perce Tribe or U.S. EPA inspectors. 40 CFR 49.132 

General Open Burning Permits 

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 Penn its cost per pennit. Fees must be paid to the NPT Air 

Quality Program prior to burning. 

Step 3. Call 208-843-9381 or 800-720-4089 to request to bum no later than 2:00 PM prior to the day of the desired bum. 

Applicants should leave a message providing the following infonnation: 

a. Name and phone number 

b. Bum name(s) ornumber(s) 

c. Date of requested bum 

d. Duration of bum if longer than one day 

e. Type and size of bum (Large Open bum, number of acres, footage or piles) 

f. Special considerations, if any (canyon rim, near highway, near a town) 

NOTE: Calling by 2:00 PM does not guarantee a next day bum approval. 

Step 4. Ifapproved, applicants will receive a preliminary bum decision and ignition time by telephone by 4:30 PM prior to the 

day of the 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 of bum requests received from applicants ("first come, first served" basis) 

d. Applicant'S record of compliance 

e. Other relevant factors 

Step 5. If the preliminary bum decision changes due to poor air quality and/or updated forecast infonnation, the NPT Air Quality 

Program will call applicant by 9:00 AM the day of the bum. 

Step 6. As a condition of this pennit, within 24 hours after the bum. you must contact the NPT Air Quality Program with your 

post bum report. Applicants should provide the following infonnation: 

a. Name 

b. Date of the bum 

c. Start and end times of the bum 

d. The size of any remaining unburned material (if the bum was not completed) 

EPA Form 7630-3 pg 1 of 4 TillS IS \'OUR P1R.rvIIT: i\\adablc Wlllk Burning 
Fonn Approved OMB 2060-0558 Approval Expires 5/31/2011 

TERMS AND CONDITIONS 

I. 	 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. 

2. 	 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. Applicants must have Baggers stationed for bums that could 

potentially impact roadways. 

3. 	 Applicants must be reachable by phone or other means of communication during the bum. If needed, the NPT or 

EPA will notify the applicant to discontinue lighting immediately. 

NOTE: The NPT Air Quality Program considers the following factors in the decision to shut down burning: 

a. Wind speed, direction, or sudden shifts 

b. Extended or high levels of smoke in the area 

c. Proximity ofsmoke to canyon rims, roadways, towns, houses, businesses, and sensitive populations 

d. Other relevant factors 

4. 	 Applicants are responsible for compliance with any applicable bum safety requirements and must also obtain 

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

S. 	 Residents and businesses are not permitted to bum structures. Contact the NPT Air Quality Program for 


information regarding disposal of these materials. 


6. 	 Fire departments must obtain a Nez Perce Reservation Air Quality Large Open Bum Permit to bum structures for 

the purpose of training 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 or asbestos-containing 

materials, or any stored prohibited items. 

NOTE: Fires are not allowed to smolder after the training session has terminated. 

7. 	 Large Open Burning is not permitted during bum bans or air pollution episodes, or when the NPT or EPA 


determines that burning will cause an adverse impact to air quality. 


8. 	 The following materials are prohibited: Paper, paper products, or cardboard more than necessary to start a fire 

it is produced at a single-family residence or residential site with four or fewer housing units; garbage; 

dead animals or parts ofdead animals; junked motor vehicles or any materials resulting from a salvage operation; 

tires or rubber materials or products; plastics, plastic products, or styrofoam; asphalt or asphaltic 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, or light bulbs; 

mercury containing materials (thermometers, computers); asbestos or asbestos-containing materials; pathogenic or 

hazardous wastes; or any material that makes dark smoke or noxious fumes other than vegetative materials. 

9. 	 Burning must be 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 

FARR permit procedures, terms and conditions are violations of the FARR and the federal Clean Air Act and are 

subject to penalties up to $37,SOO per day of violation. 

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 of the 


provided burden estimates, and any suggested methods for minimizing respondent burden, including 


through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. 


Environmental Protection Agency (2822T). 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. 


Include the OMB control number in any correspondence. Do not send the completed form to this address. 


EPA Form 7630-3 THIS IS YOUR PERJ\HT: Keep Available Whik HurnUll! 	 pg 2 of 4 
Form 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 of Acres, 

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 10ft x 20ft x 15ft 

EPA Form 7630-3 TillS IS YOUR ;\PPLJCATION: Rl::tmn 1.0 lhe '\CI I\:nx Trihe ;\ir OlldiilY Program pg 30f4 
Form 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 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. 

22. Estimated duration of burn if longer than one day: 

23. Fire Safety Methods: Please indicate the measures you will take to prevent escaped burns and smoke danger: 


[J water availability [J hand tool availability [J heavy equipment availability [J fire breaks or safety zones 


[J f1aggers [J [J other ____________ 


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 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 Name -;-:-;--;---:--~___________ Date ___ 

,<lignat!.",,,} (printed or typed) 

EPA Form 7630-3 THIS YOUR APPL1C'ATION: Rt:~turn to the ~e7 Perce Tribe pg 4 of 4
_________________ 

Permit Information 2010 

For Official Use Only. SMALL BURN 

Date Location, Quantity and 

Type of Materials Burned 

for bums under 6 ft in diameter or 30 ft or less 

of ditch bank or fence line vegetation 

AIR QUALITY PERMIT APPLICATION 

for the 


&EPA Nez Perce 


Reservation • 

Land Owner Name (Print clearly) 

Land Owner Signature 

Name of person in charge of bums 

Physical Address or Legal Description of 

the bum(s) 

Mailing Address of the Land Owner 

Cityl Statel Zip 

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 -

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8. AIR QUALITY PERMIT ... 

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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, 

what you 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 Air Act and are subject to penalties up to 

$37,500 per day of violation. 
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 

• Produced and or timber

burned at a • Pesticides or building with packaging four or fewer • 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 and 49.132 General Open Burning Pennits 


Who to Contact for more Information: 

www.nezperce.org &EPA

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 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 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 of information is estimated 

to average 0.10 hour per response. Send 

comments on the Agency's need for this 

information, the accuracy of the provided burden 

estimates, and any suggested methods for 

minimizing respondent burden, including through 

the use of automated collection techniques 

to the Director, Collection Strategies Division, 

U. S. Environmental Protection Agency (2822T), 

1200 Pennsylvania Ave., NW, Washington, D.C. 

20460. Include the OMB control number in any 

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 need a 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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Form 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 of Air Quality (OAQ) 


Region 10, OAWT 107 ..... 
 CTUIR-DOSE 

Office of Air 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 of fence line or ditch bank vegetation. Agricultural, forestry-related and small open burns require a different 

permit. Firefighter trainings require a large open bum permit. Permit applicants are responsible for following 

all instructions, terms and conditions regarding burning within the exterior boundaries of the Umatilla Indian 

Reservation. After sending in the Air Quality Large Open Burn Permit Application (pages 3-4) and receiving 

Iapproval to bum, KEEP THIS SIGNED SHEET AS YOUR PERMIT (pages 1-2). Have it available and provide it 

• upon request to the CTUIR Office of Air Quality personnel or U.S. EPA inspectors, 

40 CFR 49. 132 General Open 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. 

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

IApplicants 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 of this 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 of these rules, please contact the CTUIR OAQ. 


Tll] IS YOUIZ PElZ\l[]' While Burning pg 
Form Approved OMB 2060-0558 Approval Expires 513112011 

8. Burning conducted without authorization of the CTUIR OAQ and/or failure to follow the FARR permit 

procedures are violations of the federal Clean Air Act and the FARR and are subject to penalties up to $37.500 

per day of violation. 

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) 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 

of the 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 bum decisions. 

Burn priority will be as follows: 

a. Favorable conditions for sensitive areas (burn near towns. roads, canyons) 

b. The preferred area to be burned (in terms offorecasted conditions) 

c. The order of bum 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 of the 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 of this permit. 

3. All fires must be ignited and must be completely out within approved burn duration times. 

Post-Burn Procedures 

1. As a condition of this 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 of acres 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 s Signature is requiredfor permit 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 of the provided burden 

estimates, and any suggested methods for minimizing respondent burden, including through the use of automated 

collection techniques to the Director, Collection Strategies Division. U.S. Environmental Protection Agency (2822T). 

1200 Pennsylvania Ave .• NW. Washington. D.C. 20460. Include the OMB control number in any correspondence. 

Do not send the completed form to this address. 

EPA Form 7630-12 Tlll'S [S YOUR PFRMIT: K.cc j\\ailabk \Vhilc Burning pg2of4 
Form Approved OMS 2060-0558 Approval Expires 5/31/2011 

For Intemal Use Only 

Permit Number: Date: Initials of CTUIR Staff: 

United States Environmental Protection Agency (EPA) 

Federal Air Rules for Reservations (FARR) 

Confederated Tribes ofthe Umatilla Indian Reservation (CTUIR) 

Region 10, OAWT 1 07 ~ 

Seattle, 

12006thAve.,Ste.900 

WA 98101 .­• ., 

EA~ 

Hotline: 1-800-424-4EPA 

Fax: 206-553-0110 

www.epa.gov/r10earth/FARR.htm 

Office of Air Quality (OAQ) 

CTUIR-DOSE 

Office of Air 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 of Air 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 cr UIR OAO pg 3 of 4 
Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

pg 4 of 4 

Burn Information 

20. Map: Attach a printout or draw a map of the 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 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. 

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 ofApplicant Printed Applicant Name Date 

For Internal 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 OF AIR QUALITY PERMIT APPLICATION Date Location/Quantity and 

for bums under 6 ft in diameter or 60 ft or less Type of Materials to be of ditch 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 of the bum 

Mailing Address of the 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 OF AIR QUALITY PERMIT APPLICATION 

for the &EPA Umatilla In.dian 

Reservation 

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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 OAQ Air Quality Program and/or failure to 

follow the FARR permit procedures. terms and 

conditions are violations of FARR and the federal 

Clean Air Act 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 a fire 

• Produced and 

burned at a singlefamily residence 

• Produced and 

burned at 

a building with 

four or fewer 

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 other than 

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' 

for 

Who 

more 

to Contact 

Information: +

Confederated Tribes of the 

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 

US EPA: 1-800-424-4EPA &EPA

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. 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 of the Umatilla 

Indian Reservation. 

The public reporting and recordkeeping burden 

for Ihis collection of informalion is estimaled 

to average 0.10 hourper response. Send 

comments on lhe Agency's need for Ihis 

information. the accuracy of the provided burden 

estimales. and any suggested methods for 

minimizing respondent burden, including through 

the use of automated collection techniques 

to the Director. Collection Strategies Division. 

U.S. Environmental Protection Agency (28221). 

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. 

Approved OMS 2060-055ll V 

Approval Expiras 513112011 ~ 

We appreciate your comments or feedback. 

Please write below. 

Q: Why do I need a permit? 

A: Smoke from 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 

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om 
Form 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 6th Ave, 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 

An as;ricultural burn is the burning a/ves;etative debris (rom an agrjcultural activity that js necessary tor disease 

or pest control. or tor crop vropagation 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 

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

agricultural burning within the exterior boundaries ofthe 1863 Nez Perce Reservation. After sending in the Air 

Quality Permit Application (pages 3-4) and receiving approval to burn, THIS SIGNED SHEET IS YOUR 

PERMIT (pages 1-2). Keep it available andprovide it upon request to the Nez Perce Tribe or u.s. EPA inspectors. 

40 CFR 49.133 Agricultural Burning Permits. 

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 proposed bum date. Nez Perce Reservation Agricultural Burn Permits cost $Q per permit. 

Fees must be paid to the NPT Air Quality Program prior to burning. 

NOTE: Applicants leasing tribally-owned land must also fill out a NPT Land 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 prior to the day of 

the desired burn. From July-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 of requested bum 

d. Duration ofburn iflonger than one day 

e. Crop type and number of acres/piles for each field 

f. Special considerations, if any (canyon rim, near highway, near a town) 

NOTE: Calling by 2:00 PM does not guarantee a next day burn approval. 

Step 4. If approved, applicants will receive a preliminary bum decision and ignition time by telephone by 7:00 PM prior 

to the day of the approved bum. Ifnot approved to burn, applicants will not receive a call. Burn 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 of compliance 

e. Other relevant factors 

Step 5. If the preliminary burn decision changes due to poor air quality and/or updated forecast information, the NPT Air 

Quality Program will call applicant by 9:00 AM the day of the burn. 

EPA Form 7630-1 TillS is \'OUR PERMIT: ;\\;\ ilable Burning pg 1 of4 
Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

Step 6. Prior to ignition, the burner must speak with the NPT Air Quality Program/Field Coordinator to receive final 

approval to burn. 

Step 7. As a condition of this permit, within 24 hours after the burn. you must contact the NPT Air Quality Program with 

your post burn report. You should provide the following information: 

a. Name 

b. Date of the burn 

c. Start and end times of the burn 

d. The size of any remaining unburned material (if the burn was not completed) 

TERMS AND CONDITIONS 

1. 	 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 ofthe 1863 Nez Perce Indian Reservation. 

2. 	 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. Applicants must have fiaggers stationed for burns that could 

potentially impact roadways. 

3. 	 Applicants must be reachable by phone or other means of communication during the burn. If needed, the NPT or 

EPA will notifY the applicant to discontinue lighting immediately. 

NOTE: The NPT Air Quality Program considers the following factors in the decision to shut down burning: 

a. Wind speed, direction, or sudden shifts 

b. Extended or high levels of smoke in the area 

c. Proximity of smoke to canyon rims, roadways, towns, houses, businesses, and sensitive populations 

d. Other relevant 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 or air pollution episodes, or when the NPT or EPA 


determines that burning will cause an adverse impact to air quality. 


6. 	 The following materials are prohibited: Paper, paper products, or cardboard more than necessary to start a fire 

unless it is produced at a single-family residence or residential site with four or fewer housing units; garbage; 

dead animals or parts ofdead animals; junked motor vehicles or any materials resulting from a salvage operation; 

tires or rubber materials or products; plastics, plastic products, or styrofoam; asphalt or asphaltic 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. or light bulbs; 

mercury containing materials (thermometers, computers); asbestos or asbestos-containing materials; pathogenic or 

hazardous wastes; or any material that makes dark smoke or noxious fumes other than vegetative materials. 

7. 	 Burning must be conducted in compliance with 40 CFR 49.131 General Open Burning and 49.133 Agricultural 

Burning Permits. 

8. 	 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 the FARR and the federal Clean Air Act and are 

subject to penalties up to $37.500 per day of violation. 

The public reporting and record keeping 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 of the 


provided burden estimates, and any suggested methods for minimizing respondent burden, including 


through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. 


Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. 


Include the OMB control number in any correspondence. Do not send the completed form to this address. 


EPA Form 7630-1 TIllS IS YOUR PERMIT: A\ailablc Wbile Burning 	 pg 2 of4 
Form 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 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 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 highway or 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 

of Acres 

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 H Irs y pg 30f4 
Form 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 longer than 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 4 
Form 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 of the Umatilla Indian Reservation (CTUIR) 

Federal Air Rules for Reservations (FARR) Office of Air Quality (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 


I 

An agricultural bum is the buming of vegetative debris from an agricultural activity that is necessary for disease 

or pest control, or for 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 of the Umatilla Indian Reservation. After sending in the Air 

Quality Agricultural Burn Permit Application (pages 3-4) and receiving approval to burn, KEEP THIS SIGNED 

SHEET AS YOLIR PERMIT (pages 1-2). Have it available and provide it upon request to the CTUIR Office of Air 

Quality personnel or U.S. EPA inspectors. 40 CFR 49. 133 Agricultural 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 prior to 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. If a 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 of this 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 of these rules, please contact the CTUIR ~AO. 

TUl pg IS YOl.!R PERMIT: K<:c1' 
Form Approved OMB 2060-0558 Approval Expires 513112011 

9. Burning conducted without authorization of the CTUIR OAO and/or failure to follow the FARR permit 

procedures are violations of the federal Clean Air Act and the FARR and are subject to penalties up to $37,500 

per day of violation. 

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 

of the 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 OAO office and a 

permit number is issued by CTUIR ~AO. 

2. Applicant will be contacted by the CTUIR OAO staff when a preliminary burn day and burn time is determined. 

3 The CTUIR OAO staff will review requested fields to determine recommendation for preliminary burn decisions. 

Field burn priority will be as follows: 

a. Favorable conditions for sensitive areas (fields near towns, roads, canyons) 

b. The preferred area to be burned (in terms of forecasted 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 of communication during the day of the 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 of this permit. 

3. All fires must be ignited and must be completely out within approved burn duration times. 

Post-Burn Procedures 

1. As a condition of this 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 or fax with the following post-bum 

information: 

a. Name, as it is on application 

b. Date, time and durations of the bum(s) 

c. How the burn went and if it was completed 

d. Number of acres actually burned 

e. The size of any remaining unburned material (if bum 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 S Signature is required for permit 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 of the provided burden 

estimates, and any suggested methods for minimizing respondent burden, including through the use of automated 

collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 

1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. 

Do not send the completed form to this address. 

EPA Form 7630-10 TlHS IS YOUR PERi\lIT: K, !\\ail;lble While Burnin!l. pg2of4 
Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

For Intemal Use Only 

Permit Number: Date: Initials of CTUIR Staff: 

United States Environmental Protection Agency (EPA) Confederated Tribes of the Umatilla Indian Reservation 

Federal Air Rules for Reservations (FARR) Office of Air Quality (OAQ) 

Region 10, OAWT 107 &EPA 

CTUIR-DOSE 

1200 6th Ave., Ste. 900 Office of Air 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 of Air 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 4 

Form 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 of Indian Affairs, Umatilla Agency Date 

Natural Respurce Management Team, Bureau of Indian Affairs, Umatilla Agency Date 

24. Map: Attach a printout or draw a map of the 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 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. 

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 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 ofApplicant Printed Applicant Name Date 

For Internal Use Only 

Approved by: loate: 

, ' ,- -, EPA Form 7630-10 r1!I~) IS 'r (JU R !\ PPU('j\ pg 4 of 4 "

IlON: Return (0 the (' I UJ R O!\O 
Form 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 6th Ave, Ste. 900 

Seattle, WA 98101 

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 

A forestry burn is the burning o(vegetative debris from a forestry or silvicultural activity that is necessary tor disease or 

pest control. reduction of/ire hazard. reforestation or ecosystem management. Agricultural. small and large open burns 

require a different permit. Firifighter trainings require a large open burn permit. Permit applicants are responsible for 

following all instructions, terms and conditions regardingforestry burning within the exterior boundaries ofthe 1863 

Nez Perce Reservation. After sending in the Air Quality Permit Application (pages 3-4) and receiving approval to burn. 

THIS SIGNED SHEET IS YOUR PERMIT (pages 1-2). Keep it available and provide it upon request to the Nez 

Perce Tribe or u.s. EPA inspectors. 40 CFR 49.134 Forestry and Silvicultural Burning Permits 

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 $Jl per pennit. Fees must be paid to the NPT Air 

Quality Program prior to burning. 

Step 3. Call 208-843-9381 or 800-720-4089 to request to bum no later than 2:00 PM prior to the day of the desired bum. 

Applicants should leave a message providing the following infonnation: 

a. Name and phone number 

b. Burn name(s) or number(s) 

c. Date ofrequested bum 

d. Duration of bum iflonger than one day 

e. Type and size of bum (Forestry bum & number ofacres or piles) 

f. Special considerations, if any (canyon rim, near highway, near a town) 

NOTE: Calling by 2:00 PM does not guarantee a next day bum approval. 

Step 4. Ifapproved, applicants will receive a preliminary bum decision and ignition time by telephone by 4:30 PM prior to the 

day of the 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 of bum requests received from applicants ("first come, first served" basis) 

d. Applicant's record of compliance 

e. Other relevant factors 

Step 5. If the preliminary bum decision changes due to poor air quality and/or updated forecast infonnation, the NPT Air Quality 

Program will call applicant by 9:00 AM the day of the bum. 

Step 6. As a condition ofthis pennit, within 24 hours after the bum. you must contact the NPT Air Quality Program with your 

post bum report. You should provide the following infonnation: 

a. Name 

b. Date of the bum 

c. Start and end times of the bum 

d. The size of any remaining unburned material (if the bum was not completed) 

EPA Form 7630-2 pg 1 of4 TllfS IS YOUR PFRMn: K Ie 
Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

TERMS AND CONDITIONS 

I. 	 This pennit 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. 

2. 	 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 pennit. Applicants must have flaggers stationed for burns that could potentially 

impact roadways. 

3. 	 Applicants must be reachable by phone or other means of communication during the burn. If needed, the NPT or EPA 

will notify the applicant to discontinue lighting immediately. 

NOTE: The NPT Air Quality Program considers the following factors in the decision to shut down burning: 

a. Wind speed, direction, or sudden shifts 

b. Extended or high levels ofsmoke in the area 

c. Proximity ofsmoke to canyon rims, roadways, towns, houses, businesses, and sensitive populations 

d. Other relevant factors 

4. 	 Applicants are responsible for compliance with any applicable burn safety requirements and must also obtain applicable 

fire safety pennits. Contact your local fire district or sheriff's office for fire safety pennit infonnation. 

5. 	 Forestry Burning is not pennitted during bum bans or air pollution episodes, or when the NPT or EPA detennines that 

burning will cause an adverse impact to air quality. 

6. 	 The following materials are prohibited: 

Paper, paper produets, or cardboard more than necessary to start a fire it is produced at a single-family residence 

or residential site with four or fewer housing units; garbage; dead animals or parts of dead animals; junked motor 

vehicles or any materials resulting from a salvage operation; tires or rubber materials or products; plastics, plastic 

products, or styrofoam; asphalt or asphaltic 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, or light bulbs; mercury containing materials (thernl0meters, computers); asbestos 

Of asbestos-eontaining materials; pathogenic or hazardous wastes; or any material that makes dark smoke or noxious 

fumes other than vegetative materials. 

7. 	 Burning must be eonducted in compliance with 40 CFR 49.131 General Open Burning and 49.134 Forestry and 

Silvicultural Burning Pennits. 

8. 	 Burning conducted without pennission from the NPT ERWM Air Quality Program and/or failure to follow the FARR 

pennit procedures, tenns and conditions are violations ofthe FARR and the federal Clean Air Act and are subject to 

penalties up to $37,500 per day of violation. 

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 of the 


provided burden estimates, and any suggested methods for minimizing respondent burden. including 


through the use of automated collection techniques to the Director. Collection Strategies Division, U.S. 


Environmental Protection Agency (2822T). 1200 Pennsylvania Ave .• NW. Washington, D.C. 20460. 


Include the OMB control number in any correspondence. Do not send the completed form to this address. 


EPA Form 7630-2 	 THIS IS YOUR PFR\lIT: Keep .'\v:uJahk While B Irnillg pg 2 of 4
Form 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 www.epa.gov/r10earth/FARR.htm ~ Fax: 208-843-7411

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. If one 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 of Acres 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% 10 piles 20ft x 20ft 4,300 ft 

1 Perce 8=30% x 15ft 

EPA Form 7630-2 Till S IS 'VOL! R f\PPL!C,\TIO~.J: Return til 1h(' '(7 Perce Trib~~ :\Ir OuaJ ity Program pg 3 of 4 

Form 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 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 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 Program 
FormA roved OMB 2060-0558 A roval Ex ires 5/31/2011 

Pennlt Number: (To Be Assigned by CTUIR OAQ) 

United States Environmental Protection Agency (EPA) 
 Confederated Tribes of the Umatilla Indian Reservation 

Federal Air Rules for Reservations (FARR) 
 Office of Air Quality (OAQ) 

Region 10, OAWT 107 ~ CTUIR-DOSE 


Office of Air 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 of vegetative debris from a forestry or silvicultural activity that is necessary for 

disease or pest control, reduction of fire 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 of the 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 of Air 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 prior to 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 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 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 of the 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 of this 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 of these rules, please contact the CTUIR OAQ. 

PLRMIT: Kc:.:p pg of4
Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

8. Burning conducted without authorization of the CTUIR OAQ and/or failure to follow the FARR permit 

procedures are violations of the federal Clean Air Act and the FARR and are subject to penalties up to $37,500 

per day of violation. 

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 

of the 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 of forecasted 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 of the 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 of this permit. 


3. All fires must be ignited and must be completely out within approved burn duration times. 


Post-Burn Procedures 

1. As a condition of this 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 of the burn(s) 

c. How the burn went and if it was completed 

d. Number of acres 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 for permit 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 of the provided burden 

estimates, and any suggested methods for minimizing respondent burden, including through the use of automated 

collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 

1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. 

Do not send the completed form to this address. 

EPA Form 7630-11 pg 2 of 4 
Form Approved OMS 2060·0558 Approval Expires 5/31/2011 

For Intemal Use Only 

Permit Number: Date: Initials of CTUIR Staff: 

Confederated Tribes of the Umatilla Indian Reservation (CTUIR) 

Federal Air Rules for Reservations (FARR) 

United States Environmental Protection Agency (EPA) 

Office of Air Quality (OAQ) 

Region 10, OAWT 1 07 ~ 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 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 of Air 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 of the Burn: 

14. Requested Burn Date: 

15. Fuel Conditions: 

16. Burn Location: 

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

EPA Form 7630·11 THIS IS '{OUR APPLlCArI( pg 30f4
Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

Burn Information 

21. Map: Attach a printout or draw a map of the 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 !1llmiJor of or 

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

Method: oPropane Torch o Other 

Pattern: o Strip Burn o Circle Burn o Other 

24, Estimated duration of flaming 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 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 ofApplicant Printed Applicant Name Date 

For Internal Use Only 


Approved by: IDate: 


EPA Form 7630-11 THIS ISYOUR APPLICATION: Ih'mrl1 to the CTU1R OAr pg 4of4 ) 


FARR Registration Instructions October 5, 2005 

Instructions for Completing F ARR 


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 of the 


owner and/or operator, the location of the source, the type of business, identification of 


air pollution emitting equipment and air pollution control devices, and the type and 


quantity of air pollutants actually emitted to the environment. 


The owner or operator of an air pollution source that existed on June 7, 2005 must submit 

an initial registration form to EPA between January 1 and February 15,2007. The owner 

or operator of a new air pollution 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 of an air pollution source must re-register 

the source each year during the January 1 to February 15 registration period. 

Registrations must be submitted on the EPA forms. Copies of the registration forms may 


be obtained online at EPA Region 10's web site or by 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 "F ARR" 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 of Section D. 

A. GENERAL INFORMATION 

In this section you will provide information about the location of your air pollution source, the 

type of business that is conducted there, the owner and operator of your source and the contact 

information for certain people responsible for the operation of the source and compliance with 

air pollution requirements. 

The Source (Facility) Name is the name on your State or local business license, the name that 

you list your business under in the telephone book, or the name that you show on the sign posted 

on your source. 
F ARR Registration Instructions October 5, 2005 

The Air Quality Operating Permit Number will be the number on your EPA-issued Part 71 

operating permit or your Part 49 Non-Title V operating permit ifyou have such a permit. If you 

don't have an EPA-issued operating permit, then leave the line blank or mark it as not applicable. 

The Nature of the Business is the type ofbusiness that is conducted at your air pollution source. 

This should be 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 of your air pollution 

source. This is the information that anyone would use to contact your business or use 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 EPA can talk to about air pollution 

requirements that apply to your source, including this requirement for Initiall Annual Source 

Registration. This person can be the owner or operator, or an employee who is responsible for 

compliance with environmental or other governmental requirements, provided that person 

actually works at the location ofthe air pollution source. For the Compliance Contact, provide 

telephone and facsimile numbers, mailing address, and email address (if applicable). 

The Owner is the person or corporation that owns the business which operates the air pollution 

source. Essentially, this is the person or company that makes a profit from the business and who 

pays federal income tax on the proceeds from the business. Provide the name ofthe owner 

(individual or corporation), telephone and facsimile numbers, mailing address, and email address 

(if applicable). In addition, provide the name and title of a 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 (if applicable) for this individual. 

The Operator is the person or corporation who is responsible for the day-to-day operation ofthe 

air pollution source. Ifthe Owner is also the Operator ofthe source, then leave this section blank 

or mark it as not applicable. If the Owner has arranged for some other person or company to 

operate the air pollution source, then complete this section. The Operator may be a contractor or 

a sub-division of the parent company (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 of a 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. 

2 

F ARR Registration Instructions October 5, 2005 

The following is a sample of how to complete this portion of the Registration form. 

Identifying Information 

Source (Facility) Name John's Auto Body Shop 

Air Quality Operating Permit No. (if applicable )---,N......:.:.../A'"""'"-__________ 

Nature of the 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 Reservation Name 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 

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

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

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

---

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

FARR 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____(If different from Owner). 

Telephone (,-_-,) _______ Ext. ___ Facsimile '--_-'_______ 

Operator's 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 

4 

F ARR Registration Instructions October 5, 2005 

B. ATTACHMENTS 

In this section, you will provide more detailed information about the operation of your air 

pollution source. This information will enable you and EPA to determine the type and quantity 

of air pollutants that you 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 ofthe following information as attachments to this form: 

[J Process flow chart identifying all processing, combustion, handling, storage, and emission 

control equipment 

This is a graphical representation of the flow of raw materials, fuels, and intermediary and final 

products for your source. This process flow chart can be hand drawn or computer generated. 

However, you must clearly label all steps in your process and identify the processing equipment, 

combustion sources, material handling operations, and raw material and product storage 

facilities. You must also identify which equipment or processes produce air pollutants 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 or chimney, or indirect such as through 

building ventilation systems or even windows and doors. 

[J Narrative description of the 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 of all air pollutant generating equipment and activities; include model and serial 

numbers for portable equipment 

This is a list of the equipment and activities that generate air pollutants that are released to the 

environment. The list must include sufficient information about each of pieces of equipment 

(make, model, size, etc.) and activities (type of activity, location within the source, etc.) to enable 

EPA to identify them if we inspect the source. For portable equipment that is used at multiple 

locations, include both the model and serial numbers of the equipment. Portable equipment does 

not include mobile sources, such as cars, trucks, tractors, or forklifts, or other equipment with 

internal combustion engines such as lawnmowers or weedwackers, etc. 

[J Plot Plan 

This is a graphical representation of your entire facility, including the property upon which it is 

located and the nearby properties. This plot plan can be hand drawn or computer generated. 

However, it must clearly show: 

• The location of all air pollution 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 or commercial property. 

[J Type and quantity of fuels, including sulfur content of fuels, used on a daily, annual and 

maximum hourly basis 

If fuels are burned in your manufacturing or industrial process, then provide a written description 

ofthe type and quantity of fuels used. This description must include the types of fuels used, the 

5 

FARR Registration Instructions October 5, 2005 

sulfur content of fuels ifpetroleum-based fuels are used or if the fuels are produced on site, and 

the amount of fuel typically uscd in a day and in a year. You must also include the maximum 

amount of fuel 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 if your furnace or boiler is rated at 400,000 British thermal units (Btu) per hour or less. 

D Type and quantity of raw materials used or final product produced on a daily, annual and 

maximum hourly basis 

This is a written description of the type and quantity of raw materials typically used in a day and 

in a year. Alternatively, you can provide a description of the type and quantity ofthe final 

product typically produced in a day and in a year. The choice of which of these to provide will 

depend upon the approach used to calculate your actual emissions of air pollutants (see Section 2 

Table of Annual Emissions, below). You must also provide information on the maximum 

amount of raw material you could use in an hour, or the maximum amount of final product you 

could produce in an hour, when operating at maximum capacity (that is, the maximum rated 

capacity ofyour source). 

D Typical operating schedule, including number of hours per day, number of days per week 

and number of weeks per year 

This is a written description ofthe typical operating schedule for your air pollution 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). 

Or you may operate seasonally, for 12 hours a day, seven days a week, for a four-month period. 

If you frequently have to use double shifts, or seasonally increase your hours per day, then 

include this in your typical schedule. However, if you have to authorize overtime only 

infrequently, then do not include that in your typical schedule. 

D List of estimated efficiency of air pollution control equipment under present or anticipated 

operating conditions 

If you use any air pollution control equipment, such as multiclones, baghouses, scrubbers, or 

thermal oxidizers, then provide a list of the equipment along with the estimated control 

efficiencies. These estimated control 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 if we inspect the source. 

D Estimates of the total actual emissions from the air pollution source for 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 your total actual emissions. 

D 	 Other (provide details) 

If there is any other information about your source or its operation that relates to air pollution 

that you wish to provide, then include that information in a separate attachment. 

6 
F ARR Registration Instructions October 5, 2005 

The following is an example of the type of information to submit as attachments to your 

Registration Forms. Names and locations are fictitious and the description of operations, 

quantities, and emission factors are simplified for illustrative purposes. The example 

illustrates important concepts and demonstrates the calculation of the 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 of the Yakama Reservation. This is also the mailing address 

of the 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 of operations at John's Auto Body Shop is John Smith. He is reachable at the 


addresses above, but also by phone at (509) 555-1212, extension 100. 


In addition to John Smith, John's Auto Body Shop employs 5 journey-level body shop personnel and 

painters. They perform the hands-on work of the operation, including body repair and spray painting. 

John's Auto 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 of these sites are within the boundary of the Yakama Indian Reservation, as defined by the BIA. 

John's Auto Body Shop is one of a half dozen or so full-service auto refinishing shops in the Toppenish 

area. John's distinguishes itself from the competition by the thoroughness of the body prep work and by 

offering high-quality, multi-topcoat finishes. The growth of the business is limited by the market in the 

Toppenish area for work of this quality; the number of vehicles worked has remained fairly constant for 

the last three years, and the owner of the business sees no change of this 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 at present John's Auto Body Shop operates a single 

shift of 9 hours a day with occasional longer hours for special rush jobs. 

John's Auto Body Shop follows this process in its auto refinishing work: 

Cars, trucks and other types of vehicles arrive and are kept in storage until they come up in the work 

queue. Storage is a covered area 30 by 40 feet (for valuable 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. If any 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 while parts are stripped, or until replacements arrived, is performed. When parts return from 

stripping. or new parts arrive, the vehicle is reassembled; welding (if needed) is performed, and additional 

patching may be done. Ifbody work needs to wait for parts to catch up, the vehicle is moved off the 

7 
FARR 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 30 by 30 area just inside the garage entry doors. 

When all body work on the vehicle is completed, it is moved forward about 20 feet and prepared for 

painting. This includes washing the upper 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 catch basin, 

from which it is later removed by pumping. 

The vehicle rolls forward another 20 feet and undergoes an application of pre-coat. This is allowed to airdry. Pre-coat is applied by 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 of the 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 of two 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 by a drying period. 

Finally, the vehicle is released, either directly to the owner or back into under-cover storage awaiting 

pickup. 

Clean up ofpaint guns is done after each job by running 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 of each day. Clean up of leaks 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 spray booths 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 wear body suits and respirators while working on vehicles, 

Three ofthe work staff would be considered to be fully experienced (5 or more years in the business); the 

remaining two individuals are learning their craft on-the-job under the tutoring of the 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. 

8 

FARR Registration 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 

~ 9 
F 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 

oven 
F ARR 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 

per unit 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/surface prep 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 or four 

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 

11 

FARR Registration Instructions 10/0512005 

C. TABLE OF ANNUAL EMISSIONS 

The initial registration and annual registration must include an estimate of actual emissions 

taking into account equipment, operating conditions, and air pollution control measures. 

For an existing air pollution source that operated during the calendar year preceding the initial 

registration or annual registration submittal, the actual emissions are the actual rate of emissions 

for the preceding calendar year and must be calculated using the actual operating hours, 

production rates, in-place control equipment, and types of materials processed, stored, or 

combusted during the preceding calendar year. 

For a new air pollution source that is submitting its initial registration, the actual emissions are 

the estimated actual rate of emissions for the current calendar year. 

The procedure for estimating actual emissions for your air pollution source involves five steps: 

Step 1: Conduct a source-wide inventory of air pollutant emitting equipment and activities. 

Step 2: Identify the emission estimation method that you will use for each piece of equipment 

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 of equipment and activity. 


Step 5: Sum the emissions from all equipment and activities at your source. 


STEP 1: Conduct a source-wide inventory 

The list of air pollution generating equipment and activities developed above is your source-wide 

inventory of air pollution generating equipment and activities. 

STEP 2: Identify the emission estimation methods 

The emission estimates must be based upon actual test data or, in the absence of such 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 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 

• Other procedures 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/R I O/AIRPAGE.NSF/wcbpagc/FARR+Rcgistration+Program 

12 
FARR Registration Instructions 10/05/2005 

STEP 3: Gather appropriate records 

With the exception of in-stack continuous emission monitors, all emission estimate 

methodologies require you to have records of activity levels for your equipment or air pollution 

generating activities, such as the type and amount offuel burned, the amount ofraw materials 

processed or stored, or the amount of final product produced. You will need to collect and retain 

records of the information used in your chosen emissions estimation method. These records will 

need to cover a calendar year (January 1 through December 31) and will need to be retained for 

five years as required by EPA's Registration Rule. 

STEP 4: Calculate actual emissions for each piece of equipment and activity 

Once you have determined which emissions estimation method you will use and have gathered 

your activity records for each piece of air pollutant emitting equipment and activity, it is a simple 

process to calculate the actual emissions for the calendar year. Since each piece of equipment or 

activity will emit one or more ofthe 14 air pollutants required to be reported, it is recommended 

that you use a spreadsheet or table structure to keep track ofthe emissions from each piece of 

equipment and activity. It is then easy to sum all ofthe emissions from all equipment and 

activities to get your source-wide totals. The following is an example of how this can be done: 

Example Worksheet for Actual Emissions from Equipment and Activities for a Source with 

MuIfIpleI PoIIutants 

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 

13 

F ARR Registration Instructions 10/05/2005 

STEP 5: Sum actual emissions for entire source 

The following table should be completed by inserting estimates of the total actual emissions in 

tons/year for all pollutants contained in your worksheet stated above. 

Exam Ie Summar Table for a Source with Multiple Pollutants 

Pollutant Total Emissions 

PM 15.00 

PM10 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 ofacronyms 

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 

Both gaseous and particulate 

Sulfuric Acid Mist 

Hydrogen Sulfide 

Total Reduced Sulfur 

Reduced Sulfur Compounds. 

14 

F ARR Registration Instructions 10/05/2005 

Annual Reporting Requirements for Part 71 Sources 

Sources with Federal Operating Permits (Part 71 Permits) are exempt from all of the 

requirements ofthe Registration Rule except for the annual reporting oftheir actual emissions. 

This requirement is in addition to the Part 71 Permit requirement to report certain emissions for 

fee purposes. Part 71 sources must report their actual emissions at the same time as they are 

required to report their fee calculations. Many of the same pollutants are required to be reported 

by the Registration Rule and the Part 71 fee calculations. For these pollutants, the same 

approach for calculating actual emissions will be acceptable for both requirements. But there are 

some pollutants that are required to be reported by the Registration Rule and others that are 

required to be reported under the Part 71 program for fee purposes. These pollutants are shown 

in the following table. 

Pollutants Re uired to be Re orted under Re 

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 per year of any single 

pollutant are not counted for fee purposes. Also, emissions of pollutants 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 of Information 

You may assert a business confidentiality claim covering any portion of the 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. 

15 

FARR Registration Instructions 	 10/05/2005 

Information subject to a business confidentiality claim may be disclosed by EPA only to the 

extent set forth in the above-cited regulations. 

D. 	 OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND 

COMPLETENESS. 

This section must be completed by either the owner of the source or the operator of the source, as 

identified in Section A. above. If the owner or operator is an individual or sole proprietorship, 

then that individual or sole proprietor must be the certifying officiaL If the 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)_-=S.:..:.;m:.:...:it:..:..;h,--_(First)__J;:,.;o:.:.h~n __(Middle) Edward 

Title Owner 

Street or P.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 of Truth, Accuracy and Completeness: The Certifying Official must sign this 

statement after the form is completed. 

I certify that, based on information and belief formed 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) 

F ARR Registration Coordinator 

Office of Air Waste and Toxics 

1200 Sixth Avenue 

Seattle, W A 98101 

16 

F ARR Registration Instructions 10/05/2005 

REPORT OF CHANGE OF OWNERSHIP (EPA Form 7630-5) 

After initial registration, submit a Report of Change of Ownership in writing within 90 days 

after the effective date of change ofownership of the business or facility. 

Reports must be submitted on the EPA forms. Copies of the report forms may be obtained 

online at EPA Region 1 O's web site or by calling EPA at the number listed below. 

The EPA Region 10 "FARR" website www.cpa.gov/rl Oeartb/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 obtained by calling the "FARR" hotline, 1-800-424-4372 and asking for 

help with "F ARR" registration forms. 

Complete Section A, update any information in Section B that has changed as a result of the 

change of ownership, 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 of Section D. 

A. GENERAL INFORMATION 

In this section you will provide information about the name of the previous owner and business, 

the location of your air pollution source, the type ofbusiness that is conducted there, the owner 

and operator of your source and the contact information for certain people responsible for the 

operation of the source and compliance with air pollution requirements. 

The Previous Source (Facility) Name is the name of the business when it was operated by the 

previous owner. 

The Previous Owner's Name is the name of the individual, sole proprietorship, partnership, or 

corporation that previously owned this business. 

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 of Change of Ownership is the date that the new owner is responsible for 

the operation of the business and compliance with applicable air quality requirements. 

17 

FARR Registration Instructions 1010512005 

The following is a sample of how to complete this portion of the Report of Change of 

Ownership form. 

Identifying Information 

Previous Source (Facility) N ame __~;:..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) N arne ____---=S;.;::a~IIy.l_':.s..;.,A.;,:u:.:,t.=,o-=B;.;::o;.;::d+-y...::S:;.:.h.:,.::o+:p_____ 

Air Quality Operating Permit No. (if applicable) NIA 

Nature of the 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 Title_------":....:..:...:c..:..:::.:. Owner___ 

(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 (or PO 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's N ame ___=S=a'-'-m=e;....;a=s;;...o=w:..;..;...;.ne=r~____(If different from owner) 


New Telephone (,-_-,) ______ Ext. ___ Facsimile ('-_~)_______ 


Operator Mailing Address: Street (or PO 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 of Change of Ownership. 

Date. 06 I 01 I 2008 

19 
F ARR Registration Instructions 	 October 5, 2005 

B. ATTACHMENTS 

Update (in separate attachments to this form) any of the information listed below that has 

changed as a result of the 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 of the followine: information as attachments to this form that requires updatine: as 

a result of the change of ownership. 

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

control equipment 

D Narrative description of the production processes and air pollution control equipment 

D List of all emission units and air pollution generating activities; include model and serial 

numbers for portable equipment 

D Plot Plan 

• 	 Location of all emission units and air pollution generating activities 

• 	 Property lines for the air pollution source 

• 	 Elevation above grade for each emission release point 

• 	 Distance and direction to nearest residential or commercial property. 

D 	 Type and quantity of fuels, including sulfur content of fuels, used on a daily, annual and 

maximum hourly basis 

D 	 Type and quantity of raw materials used or final product produced on a daily, annual and 

maximum hourly basis 

D 	 Typical operating schedule, including number of hours per day, number of days per week 

and number of weeks per year 

D 	 List of estimated efficiency of air pollution control equipment under present or anticipated 

operating conditions 

D 	 Estimates of the total actual emissions from the air pollution 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). 

20 

F ARR Registration Instructions October 5, 2005 

C. TABLE OF EMISSIONS 

Pollutant Total Emissions 

PM 

PMIO 

PM2.5 

SOx 

NOx 

CO 

VOC 

Pb 

NH3 

Fluorides 

H2SO4 

H2S 

TRS 

RSC 

Definition ofacronyms 

PM Particulate Matter 

PM10 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 

H2S04 Sulfuric Acid Mist 

H2S Hydrogen Sulfide 

TRS Total Reduced Sulfur 

RSC Reduced Sulfur Compounds. 

Confidential Treatment of Information 

You may assert a business confidentiality claim covering any portion of the 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. 

21 
F ARR Registration Instructions October 5,2005 

D. OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND 


COMPLETENESS. 


This section must be completed by either the owner of the source or the operator of the 

source, as identified in Section A. above. If the owner or operator is an individual or sole 

proprietorship, then that individual or sole proprietor must be the certifying official. If the 

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 of Truth, Accuracy and Completeness: The Certifying Official must sign this 

statement after the form is completed. 

I certify that, based on information and belief formed 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 of Air Waste and Toxics 


1200 Sixth Avenue 


Seattle, WA 98101 


22 
FARR Registration Instructions October 5, 2005 

REPORT OF CLOSURE (EPA Form 7630-6) 

Except for regular seasonal closures, after initial registration, submit a Report of Closure in 

writing within 90 days after cessation of all operations. 

Reports must be submitted on the EPA forms. Copies of the report forms may be obtained 

online at EPA Region 10's web site or by calling EPA at the number listed below. 

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 obtained by calling the "FARR" hotline, 1-800-424-4372 and asking 

for help with "FARR" registration forms. 

Complete Section A, provide the information in Section B, complete and sign Section C, 

and mail the completed form and attachments to the address listed at the end of Section C. 

A. GENERAL INFORMATION 

The Effective Date of the Source Closure is the date when all activities related to the 

operation of the business and all activities related to the shutdown of operations 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. 

23 

F ARR Registration Instructions October 5, 2005 


The following is a sample of how to complete this portion of the Report of Closure form. 


Identifying Information 

Source (Facility) Name,____s::::.a~I~lyr...::'s::....:...:A~ut.!..:o~B.::::.;od::..yI......:::::S..:..:h.::::.;opl=________ 

Effective Date of the Source Closure --.!Q.j 01 I 2010 

Air Quality Operating Permit No. (ifapplicable)___..... N.....I__A_____________ 

Nature of the 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 N ame___--..:.Y.::::,a:.,:;ka=:.m.!,.:;a:::....:.;R:,:::e::::,se:::;.:r:..,:v:..:::a:.:.t.:,::io..:..:n'---_______ 


Compliance Contact __---=S;,;:a""'"..... y-"J::....;:o::;.:,n.:.::e:.:;s~__ Title__..-.:O:;..:;w.:.:,n.:.;:e:;:..r___


(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 #) __.;;.;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 (or PO 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~______(If different from owner) 


Telephone ~) ______ Ext. ___ Facsimile ~)_______ 


Operator's Mailing Address: Street (or PO 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 


25 

I 

F ARR Registration Instructions October 5,2005 

B. REPORT OF CLOSURE. 

Provide a written description of closure activities and/or care and maintenance activities 

performed at the source and a statement describing the duration of the source closure. (e.g. 

temporary vs. permanent). This should include a description of any partial operation ofthe 

source, any temporary storage of equipment or materials, and any demolition activities that 

will occur at the plant site. 

Confidential Treatment of Information 

You may assert a business confidentiality claim covering any portion of the 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. 

26 

F ARR Registration Instructions October 5, 2005 

C. OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND 

COMPLETENESS. 

This section must be completed by either the owner of the source or the operator of the 

source, as identified in Section A. above. If the owner or operator is an individual or sole 

proprietorship, then that individual or sole proprietor must be the certifying official. If the 

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 of Truth, Accuracy and Completeness: The Certifying Official must sign this 

statement after the form is completed. 

I certify that, based on information and belief formed 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) 

F ARR Registration Coordinator 

Office of Air Waste and Toxics 

1200 Sixth Avenue 

Seattle, W A 98101 

27 

FARR Registration Instructions October 5, 2005 

[This page deliberately left blank.] 

28 

F ARR Registration Instructions October 5, 2005 

REPORT OF RELOCATION (EPA Form 7630-7) 

For any source relocation after initial registration, submit a Report of Relocation in writing 

no later than 30 days prior to relocation ofthe source. 

Reports must be submitted on the EPA forms. Copies of the report forms may be obtained 

online at EPA Region 10's web site or by 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 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, update any information in Section B that has changed as a result of 

the change of ownership, 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 of Section D. 

A. GENERAL INFORMATION 

In this section you will provide information about the previous location of the business, the 

new location of your air pollution source, and any changes to the type of business that is 

conducted there or the contact information for certain people responsible for the operation of 

the source and compliance with air pollution requirements. 

The New Source Physical Address is the new location of your business after the relocation. 

The Previous Physical Address is the old location of your business 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 of Source Relocation is the date that business operations begin at the 

new location and air pollutant generating equipment or activities begin operation. 

29 

F ARR Registration Instructions October 5, 2005 

The following is a sample of how to complete this portion of the Report of Change 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 

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

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

----

F ARR 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 (or PO 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 

Contact Mailing Address: Street (or PO Box #) _--=2:;;..;0:;..:;2:...;M:..:..:.:a:.:..!in..:....=S~t:.....__ 

C City_--'-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 (or PO Box #) _____________ 


_________ 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 #) _______ 

_________ County______State ___ ZIP ______ 

e.mail address 

Effective Date of Source Relocation. 

Date.JQj 01 I 2009 

31 
F ARR Registration Instructions 	 October 5, 2005 

B. 	REPORT OF RELOCATION 

Provide a written description of relocation activities. Update (in separate attachments to this 

form) any of the 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 of the following information as attachments to this form that requires updating as 

a result of the change of ownership. 

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 air pollution generating activities; include model and serial 

numbers for portable equipment 

o 	 Plot Plan 

• 	 Location of all 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 of fuels, including sulfur content of fuels, used on a daily, annual and 

maximum hourly basis 

o 	 Type and quantity of raw materials used or final product produced on a daily, annual and 

maximum hourly basis 

o 	 Typical operating schedule, including number of hours per day, number of days per week 

and number of weeks per year 

o 	 List ofestimated efficiency of air pollution control equipment under 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) 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). 

32 

F ARR Registration 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 ofacronyms 

PM 

PM10 

PM25 

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 

Both gaseous and particulate 

Sulfuric Acid Mist 

Hydrogen Sulfide 

Total Reduced Sulfur 

Reduced Sulfur Compounds. 

Confidential Treatment of Information 

You may assert a business confidentiality claim covering any portion of the 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. 

33 

F ARR Registration Instructions October 5, 2005 

D. OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND 

COMPLETENESS. 

This section must be completed by either the owner ofthe source or the operator of the 

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. If the 

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: M....._____ (Last) __=J=on:..:.::e=s~__(First) Sally (Middle ) ____......ae _ 


Title Owner 


Street or P.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 of Truth, Accuracy and Completeness: The Certifying Official must sign this 

statement after the form is completed. 

I certify that, based on information and bel~ef formed after reasonable inquiry, the statements 

and information contained in these documents are true, accurate and complete. 

Name,~,~~,,__,___________________________ 

Name (printed or typed) __------"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 of Air Waste 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 FOR INDIAN RESERVATIONS 

INITIAL / ANNUAL SOURCE REGISTRATION 

Applicability: Air pollution sources regulated by 40 Code of Federal Regulations Part 49.138. 

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

INSTRUCTIONS: Complete applicable parts of Sections A, B, C and D. 

A. GENERAL INFORMATION 

Identifying Information 

Source (Facility) Name_________________________ 

Air Quality Operating Permit No. (if applicable)________________ 

Nature of the 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 (or PO 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 (or PO 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___________________(If different from Owner). 


Telephone ________ Ext. _____ Facsimile _______ 


Operator's Mailing Address: Street (or PO 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 (or PO Box #) _________________ 


City________ --••.1 _____________ State ___ZIP ________ 

e.mail address 

EPA Form 7630-4 Page 2 of6 
Form Approved OMB 2060-0558 Approval Expires 5/31/20 II 

B. ATTACHMENTS 

Include all of the following information as attachments to this form 

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

o 	Narrative description of the production processes and air pollution control equipment 

o 	List of all emission units and air pollution generating activities; include model and serial numbers for portable 

equipment 

o 	Plot Plan 

./ Location of all emission units and air pollution generating activities 


./ Property lines 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 of fuels, including sulfur content of fuels, used on a daily, annual and maximum hourly basis 

o 	Type and quantity of raw materials used or final product produced on a daily, annual and maximum hourly basis 

o 	Typical operating schedule, including number of hours per day, number ofdays per week and number of weeks 

per year 

o 	List of estimated efficiency of air pollution control equipment under present or anticipated operating conditions 

o 	Estimates of the 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 of Information 

You may assert a business confidentiality claim covering any portion of the 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. 

EPA Form 7630-4 	 Page 3 of6 
Form Approved OMB 2060-0558 Approval Expires 5/31120 II 

C. T ABLE OF ANNUAL EMISSIONS 

The following table should be completed by inserting estimates of the total actual emissions in tons/year 

for all pollutants contained in your worksheet stated above. 

• Pollutant Total 

Emissions 

PM 

PM10 

PM 2.5 

iSOX 

. NOx 

CO 

VOC 

Pb 

NH3 

Fluorides 

H2SO4 

H2S 

TRS 

RSC 

Definition ofacronyms 

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 5/31/20 II 

D. OWNER OR OPERATOR 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. Box 

Telephone '----'______ Facsimile --'---- '---'--------­

e.mail 


Certification of Truth, Accuracy and Completeness: The Certifying Official must sign this statement after the 

form is completed. 

I certify that, based on information and belief formed after reasonable inquiry, the statements and information 

contained in these documents are true, accurate and complete. 

Name,~·l~..~·_'___________________________________________ 


Name (printed or typed)________________,Date__I__I_____ 


Return completed forms and attachments to: 

EPA Region 10 (OAWT-I07) 

F ARR Registration Coordinator 

Office ofAir Waste and Toxics 

1200 Sixth Avenue 

Seattle, W A 98101 

The public reporting and recordkeeping burden for this collection of information is estimated at 

5.61 hours on average Send comments on the Agency's need for this information, the accuracy 

of the provided burden estimates, and any suggested methods for minimizing respondent burden, 

including through the use of automated collection techniques to the Director, Collection 

Strategies Division, 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 of6 
Form Approved OMB 2060"()558 Approval Expires 5/31/2011 

FARR REGISTRATION APPLICATION INSTRUCTIONS 

GENERAL INFORMATION 

Identifying Information 

FACILITY 

Enter the name and the correct street address or other physical location ofthe facility (e.g. Acme Road or 


Building 3, XYZ Industrial Park) together with telephone and facsimile numbers. 


Provide a brief description of the nature ofthe business conducted by the facility. 


Provide name of the 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 of the owner and operator of the facility for which this application is being prepared. For 

individual owners, list the full name (last, middle initial, first). For multiple ownership where no legal business 

partnership exists, provide the name and mailing address, if different, of each individual owner using a backslash 

(\) to separate data for each owner. For corporations, include divisions or subsidiary name, if any. Enter the 

complete mailing address of the 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 of actual emissions taking into account 

equipment, operating conditions, and air pollution control measures. For an existing air pollution source that 

operated during the calendar year preceding the initial registration or annual registration submittal, the actual 

emissions are the actual rate of emissions 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 of emissions for the current calendar year. The 

emission estimates must be based upon actual test data or, in the absence of such 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) Other engineering 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 PROTECTION AGENCY 

oEM REGION 10 FEDERAL AIR RULES FOR INDIAN RESERVATIONS 

REPORT OF RELOCATION 

Applicability: Air pollution sources regulated by 40 Code ofFederal Regulations Part 49.138. 

INSTRUCTIONS: For any source relocation after initial registration, the owner or operator of an air pollution 

source must submit a report of relocation in writing no later than 30 days prior to relocation of the source. 

A. GENERAL INFORMATION 


1. 	 Identifying Information 

Source (Facility) 

Air Quality Operating Permit No. (if applicable) ________________ 

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 5/31/20 II 

A. GENERAL INFORMATION Cont. 

Owner's 

Telephone '-_-' ________ Ext. ____ Facsimile _______ 

Owner Mailing Address: Street (or PO 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 _________________CIf different from owner) 

Telephone (~ ________ Ext. ____ Facsimile '--_-'_______ 

Operator's Mailing Address: Street Cor PO 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 Source Relocation. 

Date / / 

EPA Form 7630·7 	 Page 2 of6 
Form Approved OMB 2060-0558 Approval Expires 5/31120)) 

B. REPORT OF RELOCATION 

1. 	 Provide: A written description ofrelocation activities. Update any ofthe information listed below that will 

change as a result ofthe relocation. 

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 of all emission units and air pollution generating activities; include model and serial numbers for portable 

equipment 

o 	Plot Plan 

V' Location of all emission units and air pollution 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 commercial property. 


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

o 	Type and quantity of raw materials used or final product produced on a daily, annual and maximum hourly basis 

o 	Typical operating schedule, including number of hours per day, number of days per week and number of weeks 

per year 

o 	List of estimated efficiency of air pollution control equipment under present or anticipated operating conditions 

o 	Estimates of the 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 of Information. 

You may assert a business confidentiality claim covering any portion of the 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. 

EPA Fonn 7630-7 	 Page 3 of6 
Fonn Approved OMB 2060-0558 Approval Expires 5/3112011 

B. ATTACHMENTS 

2. 	 TABLE OF ANNUAL EMISSIONS. 


Update if emissions will change as a result of relocation. 


The following table should be completed by inserting estimates of the 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 ofacronyms. 

PM10 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 Acid Mist 

H2S Hydrogen Sulfide 

TRS Total Reduced Sulfur and reduced 

sulfur compounds. 

EPA Fonn 7630-7 	 Page 4 of6 
------------------

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

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 of Truth, Accuracy and Completeness: The Certifying Official must sign this statement after the 

form is completed for each applicable requirement. 

I certify that, based on information and belief formed after reasonable inquiry, the statements and information 

contained in these documents are true, accurate and complete. 

Name (printed or typedL ________________Date__I__I__ 

e.mail address 

Return completed forms and attachments to: 

EPA Region 10 (OAWT-I07) 

F ARR Registration Coordinator 

Office ofAir Waste and Toxics 

1200 Sixth Avenue 

Seattle, W A 98101 

The public reporting and recordkeeping burden for this collection of information is estimated at 

5.61 hours on average. Send comments on the Agency's need for this information, the accuracy 

of the provided burden estimates, and any suggested methods for minimizing respondent burden, 

including through the use of automated collection techniques to the Director, Collection 

Strategies Division, 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 of6 
Form Approved OMB 2060-0558 Approval Expires 5/31/20 II 

FARR REGISTRA TION APPLICATION INSTRUCTIONS. 

GENERAL INFORMATION. 

IdentifYing Information. 

FACILITY. 

Enter the name and the new street address or other physical location of the facility ( e.g. Acme Road or Building 


3, XYZ Industrial Park) together with telephone and facsimile numbers. 


Provide a brief description ofthe nature of the business conducted by the facility. 


Provide name of the 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 OPERA TOR. 

Enter the name of the owner and operator of the facility for which this application is being prepared. For 

individual owners, list the full name (last, middle initial, first). For multiple ownership, where no legal business 

partnership exists, provide the name and mailing address, if different, of each individual owner using a backslash 

(\) to separate data for each owner. For corporations, include divisions or subsidiary name, if any. Enter the 

complete mailing address ofthe owner. 

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 of actual emissions taking into account 

equipment, operating conditions, and air pollution control measures. For an existing air pollution source that 

operated during the calendar year preceding the initial registration or annual registration submittal, the actual 

emissions are the actual rate of emissions for the preceding calendar year and must be calculated using the actual 

operating hours, production rates, in-place control equipment, and types of materials processed, stored, or 

combusted during the preceding calendar year. For a new air pollution source that is submitting its initial 

registration, the actual emissions are the estimated actual rate of emissions for the current calendar year. The 

emission estimates must be based upon actual test data or, in the absence of such 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 Other engineering calculations; or 


(v) Other procedures 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: Air pollution sources regulated by 40 Code of Federal Regulations Part 49.138. 

INSTRUCTIONS: Except for regular seasonal closures, after initial registration, the owner or operator of an 

air pollution source must suhmit a report of closure in writing within 90 days after cessation of all operations. 

A. GENERAL INFORMATION 


1. 	 Identifying Information 

Source (Facility) 

Effective Date of the Source Closure __1__1____ 

Air Quality Operating Permit No. (if applicable)_ 

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,________________(,If different from owner) 


Telephone '--_-' ________ Ext. ____ Facsimile '--_-'____ 


Operator's Mailing Address: Street (or PO 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 of5 
Fonn Approved OMB 2060-0558 Approval Expires 5/31120 I J 

B. REPORT OF CLOSURE. 

1. 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). 

Confidential Treatment of Information. 

You may assert a business confidentiality claim covering any portion of the 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. 

EPA Fonn 7630-6 Page 3 of5 
-----------------------------------------------------------

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

C. OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND 

COMPLETENESS 

1. 	 Certifying Official Information: Identify the certifying official and provide contact infonnation. 

Name: (Last), ________(First)_______(,Middle)_____ 

Title 


Street or P.O. 


City_________County_____________,State_________ZIP___________ 

Telephone {->__-____ Ext._____ Facsimile {->___________ 

2. 	 Certification of Truth, 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) ________________________ 

N arne (printed or 

Return completed forms and attachments to: 

EPA Region 10 (OAWT) 

F ARR Registration Coordinator 

Office of Air Waste and Toxics 

1200 Sixth Avenue 

Seattle, W A 9810 1 

The public reporting and recordkeeping burden for this collection of infonnation is estimated at 

5.61 hours on average. Send comments on the Agency's need for this infonnation, the accuracy 

of the provided burden estimates, and any suggested methods for minimizing respondent burden, 

including through the use of automated collection techniques to the Director, Collection 

Strategies Division, 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 of5 
Form Approved OMB 2060..(J558 Approval Expires 5/31/2011 

FARR REGISTRATION APPLICATION INSTRUCTIONS. 

GENERAL INFORMATION. 

Identifying Information. 

FACILITY. 

Enter the name and the correct street addressor other physical location of the facility ( e.g. Acme Road or 


Building 3, XYZ Industrial Park) together with telephone and facsimile numbers. 


Provide a brief description 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. 


OWNER AND OPERATOR. 

Enter the name ofthe owner and operator of the facility for which this application is being prepared. For 

individual owners, list the full name (last, middle initial, first). For multiple ownership, where no legal business 

partnership exists, provide the name and mailing address, ifdifferent, of each individual owner using a backslash 

(\) to separate data for each owner. For corporations, include divisions or subsidiary name, if any. 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 of actual emissions taking into account 

equipment, operating conditions, and air pollution control measures. For an existing air pollution source that 

operated during the calendar year preceding the initial registration or annual registration submittal, the actual 

emissions are the actual rate of emissions for the preceding calendar year and must be calculated using the actual 

operating hours, production rates, in-place control equipment, and types of materials processed, stored, or 

combusted during the preceding calendar year. For a new air pollution source that is submitting its initial 

registration, the actual emissions are the estimated actual rate of emissions for the current calendar year. The 

emission estimates must be based upon actual test data or, in the absence of such 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) Other engineering calculations; or 

(v) Other procedures 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 FOR INDIAN RESERVATIONS 

REPORT OF CHANGE OF OWNERSHIP 

Applicability: Air pollution sources regulated by 40 Code of Federal Regulations Part 49.138. 

Report change of ownership within 90 days after the effective date of change. 

INSTRUCTIONS: Complete applicable parts of Sections 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. (if applicable) ________________ 


Nature of the Business. _________________________ 


Telephone <--:) ______ Facsimile '--_-'_______ 


Source Physical Address: Street __________________ 


City__________County_______ State ____ ZIP ________ 


Indian Reservation 


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 7630-5 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 (or PO 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 of Change of Ownership 

EPA Form 7630-5 Page 2 of6 
Form Approved OMB 2060-0558 Approval Expires 5/3112011 

B. ATTACHMENTS 

Include any of the following information as attachments to this form that requires updating as a result of the 

change of ownership 

[J 	Process flow chart identifying all processing, combustion, handling, storage, and emission control equipment 

[J 	Narrative description of the production processes and air pollution control equipment 

[J 	 List of all emission units and air pollution generating activities; include model and serial numbers for portable 

equipment 

[J 	Plot Plan 

,/' Location of all emission units and air pollution generating activities 


,/' Property lines for the air pollution 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 of fuels, used on a daily, annual and maximum hourly basis 

[J 	Type and quantity ofraw materials used or final product produced on a daily, annual and maximum hourly basis 

[J 	Typical operating schedule, including number ofhours per day, number ofdays per week and number of weeks 

per year 

[J 	List of estimated efficiency of air pollution 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 Treatment of Information 

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 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 

EPA Form 7630-5 	 Page 3 of6 
Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

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 your worksheet stated above. 

Pollutant 	 I Total I 

. Emissions 

.PM 

PM10 

PM 2.5 

SOx 

NOx I

.CO 

VOC 

i Pb 

NH3 

Fluorides 

H2SO4 

H2S 

TRS 

RSC LDefinition ofacronyms 

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 of Truth, Accuracy and Completeness: The Certifying Official must sign this statement after the 

form is completed. 

I certify that, based on information and belief formed 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: 

EP A Region 10 (OA WT) 

F ARR Registration Coordinator 

Office of Air Waste and Toxics 

1200 Sixth Avenue 

Seattle, WA 98101 

The public reporting and recordkeeping burden for this collection of information 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 of automated 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 5 of6 
Form Approved OMS 2060-0558 Approval Expires 5/31/2011 

FARRREGISTRATION APPLICATION INSTRUCTIONS 

GENERAL INFORMATION 

Identifying Information 

FACILITY 

Enter the name and the correct street address or other physical location of the facility (e.g. Acme Road or 


Building 3, XYZ Industrial Park) together with telephone and facsimile numbers. 


Provide a brief description of the nature of the business conducted by the facility. 


Provide name of the 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 I OPERA TOR 

Enter the name of the new owner and operator of the facility for which this application is being prepared. For 

individual owners, list the full name (last, middle initial, first). For multiple ownership where no legal business 

partnership exists, provide the name and mailing address, if different, of each individual owner using a 

backslash (\) to separate data for each owner. For corporations, include divisions or subsidiary name, if any. 

Enter the complete mailing address of the 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 of actual emissions taking into account 

equipment, operating conditions, and air pollution control measures. For an existing air pollution source that 

operated during the calendar year preceding the initial registration or annual registration submittal, the actual 

emissions are the actual rate of emissions for the preceding calendar year and must be calculated using the 

actual operating hours, production rates, in-place control equipment, and types of materials processed, stored, or 

combusted during the preceding calendar year. For a new air pollution source that is submitting its initial 

registration, the actual emissions are the estimated actual rate of emissions for the current calendar year. The 

emission estimates must be based upon actual test data or, in the absence of such 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) Other engineering calculations; or 

(v) Other procedures to estimate emissions specifically approved by the Regional Administrator. 

EPA Form 7630-5 Page 60f6 


Fonn Approved OMB 2060-0558 Approval Expires 5!3l1201l 

&EPA U.S. Environmental Protection Agency 

Region 10 Federal Air Rules for Reservations, 40 CFR 49.139 

Non-Title V Operating Permit Application Form 


Instructions 


1. Assistance on Non-Title V Operating Permits 

Any air pollution source (facility) wishing to request federally-enforceable limitations on their 

actual emissions or potential to emit should become familiar with the Region 10 Federal Air 

Rules for Reservations (F ARR), the application form, and these instructions. The F ARR was 

originally published in the Federal Register on 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 F ARR 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 CFR 49.139. 

The F ARR website provides additional background information on the rule and implementation 

of the 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 FARR Authority? 

The F ARR applies only to sources located within the exterior boundaries of an Indian reservation 

in Idaho, Oregon and Washington or other reservation lands as specified in 40 CFR part 49, 

subpart M. So, to use the authority in the F ARR to create federally-enforceable limitations, a 

facility must be located within a reservation in one of those states. Land ownership status (for 

example, whether the land is owned by a Tribal member or whether the land is owned in fee or in 

trust) does not affect how 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 Act program, 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 of the 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 of Significant Deterioration (PSD) construction permitting program, (2) the 

Title V operating permit program, 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. If a 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. When planning for the construction of a new source or 

expansion of an existing source, a source can also accept limitations on PTE (using a non-Title V 

EPA Fonn 7630-9 Page 1 of 4 
Fonn 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 of Information 

A company may assert a business confidentiality claim covering any portion of the submitted 

infonnation as provided in 40 CFR part 2, subpart B. Please submit any infonnation claimed as 

confidential business infonnation separately, along with a claim of confidentiality. 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 CFR part 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 of Application Form 

There are three individual sections of the fonn which specify the required infonnation as well as 

the additional infonnation that must be attached to the fonn. The entire fonn must be completed, 

including the certification of truth, 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 of business 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. If the source does not have a street 

address, a brief description of the physical location of the 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 of many federal 

Clean Air Act requirements (such as Title V, PSD and MACT) is often based on facility-wide 

EPA Fonn 7630-9 Page 2 of4 
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emission levels of specific 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 of the 

application form. 

Item I The requested limitation and its effect on actual emissions or potential 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, if applicable, 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 air pollutant 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 after the limitation is in effect 

Item 2 - For each requested limitation, the application must include proposed testing, monitoring, 

record keeping 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 or process 

parameters that will be relied on and should address frequency, methods, and quality assurance. 

Item 3 - A narrative description of all of the 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 major pieces of 

equipment that combust, process, handle or store materials or products. The narrative description 

should follow the flow of the process flow diagram and address all of the 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 production process 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 per day, days per week, and weeks per year. 

Item 4 - The application must include a list of emission units and air pollution-generating 

activities that will be affected by the requested limitation. Each listed emission unit should be 

addressed by Items I through 8 to the extent applicable. 

Item 5 The application must include a list of the type and quantity of fuels 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 or raw materials, Items I and 2. 

Item 6 The application must include a description and estimated efficiency of air pollution 

control equipment under present or anticipated operating conditions. For control equipment that 

is not proposed to be modified to meet the requested limit, simply note that fact; however, for 

equipment that is proposed to be modified (e.g. improved efficiency) or newly 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 be presented in short 

term (e.g. pounds per hour) as well as annual (tons per year) 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 of4 
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allowable operating rates and anticipated controls. All of the 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, should be clearly documented with the calculations. References for each emission factor 

and any other resources used for developing the emission inventory should also be included with 

the emission estimates. 

Emission estimation tools and techniques can be found on line at http://www.epa.gov/ttn/chief: 

Estimates of actual emissions must be based upon actual test data, or in the absence of such data, 

upon procedures acceptable to the Regional Administrator. Any emission estimates submitted to 

the Regional Administrator must be verifiable using currently accepted engineering criteria .. Be 

aware that the resulting non-Title V permit will likely require verification of compliance with the 

requested limitation; so reliable emission estimation techniques are important. The following 

procedures 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 

• 	 Other procedures to estimate emissions specifically approved by the Regional 

Administrator. 

Section C Certification of Truth, Accuracy and Completeness 

The owner or operator of the facility must certify the truth, accuracy and completeness of the 

statements and information in and attached to the application form. The application must be 

signed and dated prior to submittal. If there is more than one owner, list the other owners on an 

attachment. For example, the owner(s) could be an individual, a partnership, a company, a parent 

company, or any combination of these. 

EPA Form 7630-9 	 Page 40f4 
Form 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. For additional 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 of Air Pollution Source: _______________________________ 

Nature of the 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: __________________________________ 

Telephone Number: 

5. Ope rator Name (if different from Owner): 

Mailing Address: _____________________________________ 

Telephone Number: __________________________________ 

EPA Form 7630-9 	 Page 1 of2 
Form Approved OMB 2060-0558 Approval Expires 5/31/2011 

B. 	 Limitation Request 

For each 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 of its effect on actual emissions or the potential to emit. 

2. 	 The proposed testing, monitoring, recordkeeping and reporting requirements to be used to demonstrate and assure 

compliance with the proposed limitation. 

3. 	 A description of the production processes and a related process flow chart. 

4. 	 A list of emission units and air pollution-generating activities. 

5. 	 The type and quantity offuels and/or raw materials used. 

6. 	 A description and estimated efficiency of air pollution control equipment under present or anticipated operating 

conditions. 

7. 	 Estimates of the current actual emissions and current potential to emit, including all calculations for the estimates. 

8. 	 Estimates of the allowable emissions and/or potential to emit that would result from compliance with the proposed 

limitation, including all calculations for the estimates. 

C. 	 Certification of Truth, Accuracy and Completeness 

The Owner or Operator (listed above) must sign this statement before submittal of this application form. 

I certify that, based on information and belief formed after reasonable inquiry, the statements and 

information in and attached to this form are true, accurate and complete. 

Owner or Operator (circle one) Name: 

Owner or Operator Signature: _____ 	 Date: 

The public reporting and recordkeeping burden for this collection of information is estimated at 88.33 

hours per response on average. Send comments on the Agency's need for this information, the accuracy of 

the provided burden estimates, and any suggested methods for minimizing respondent burden, including 

through the use of automated collection techniques to the Director, Collection Strategies Division, 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 7630-9 	 Page 2 of2