**FORM A -1** 

**COMPA NY INFORMA**  **TION I. Parent Company / Legal Corporate Owner Information**  1. Legal Parent Company / Legal Corporate Name 2. Mailing Address 3. City 4. State 5. Zip Code 6. County 7. Size of Com pany

(approximate number of employ ees including all subsidiaries, branches, and related establishments owned):



### Page 1 of 1 **DRA FT** PVC Section 114 Survey Part 1 06/23/2009**FORM A -2** 

**FA CILITY INFORMA** 

**TION II. Polyvinyl Chloride and Copolymers (PVC) Production Facility Information**  1. Facility

Name Facility Address a. Street b. City c. State d. Zip Code e. County Facility Coordinates (Decimal Degrees to the 5th decimal place) f. Latitude g. Longitude 2. Number of employ ees attached to the PVC production facility : **III. Technical Contact** 1. Name 2. Technical Contact Title 3. Telephone 4. Facsimile 5. Em ail **IV. Other** 1. Is the facility

a major source of HAP? 2. If No, did the facility

take a limit of its potential HAP em issions to avoid classification as a major source? 3. If the facility

took a limit of its potential HAP em issions to avoid classification as a major source, provide the date on which the limit was taken (MM/DD/YYYY). 4. Does the facility

manufacture other products in addition to PVC resin? 5. If Yes, list the other products manufactured at the facility

. 6. Are there any

HAP em issions associated with any co-located facilities?



### Page 1 of 1 **DRA FT** PVC Section 114 Survey Part 1 06/23/2009**FORM D-2**

**30 DA Y RESIN SA**  **MP LING - STRIPPER OUTLET(S)** 

**Instructions**

2. Do not submit partial data for any day : each day

must include (at a minimum) concentration analysis results for all HAP in Table 10 to Subpart HHHHHHH of 40 CFR Part 63. 3. Complete columns 1 through 30. Enter the sample date, resin ty pe, daily resin production, number of samples composited, number of resin strippers sampled, analy sis date, lab report ID, and lab sample ID. Enter the concentration results for each HAP listed. 4. Provide the total daily production from the resin strippers samples for the ty pe of resin. If your final product is sold as a dried resin, report production on a dry basis. If your final product is sold as a wet resin report production on a wet basis. 4. Enter any

other HAP expected to be present (that are not listed in Table 10 to Subpart HHHHHHH of 5. For compounds that were not detected, indicate as such in the "Non-Detect?" column and provide the method detection limit, in ppmw, in the "Concentration (ppmw)" column. 6. Enter any

notes or additional information relevant to the sampling or analysis. 7. Refer to Attachment B of Enclosure 1 "Summary of Test Procedures, Methods, and Reporting Requirements For Resin and Process W astewater Sampling and Analysis at Poly viny l Chloride and Copoly me r (PVC) Facilities" for additional instructions and information.

**CA S No.**  **HA P**  107211 Ethy lene gly col 67561 Methanol 75070 Acetaldehyde 50000 Formaldehyde 51285 2,4-dinitrophenol 98862 Acetophenone 117817 Bis(2-ethy lhexy l) phthalate (DEHP) 123319 Hydroquinone 108952 Phenol 79345 1,1,2,2-tetrachloroethane 106990 1,3-butadiene 540841 2,2,4-trimethy lpentane 71432 Benzene 108907 Chlorobenzene 67663 Chloroform 126998 Chloroprene 98828 Cumene 75003 Ethy l chloride (Chloroethane) 100414 Ethy lbenzene 107062 Ethy lene dichloride (1,2-Dichloroethane) 75343 Ethy lidene dichloride (1,1-Dichloroethane) 74873 Methy l chloride (Chloromethane) 75092 Methy lene chloride 110543 n-Hexane 108883 Toluene 71556 Methy l chloroform (1,1,1-Trichloroethane) 79005 1,1,2-Trichloroethane **If Other, Please Provide a Description of the Resin Type -->**
**Number of Resin Strippers Sampled to Obtain Composite**

**Number of Samples Composited for A nalysis**  **Total Daily Resin Production Rate (lbs of resin per day from sampled resin strippers) Resin Type (suspension, dispersion, bulk, etc.) -->**  1. Complete the table below for each resin ty pe produced by the facility

during the 30 days of sampling. If the facility produced more than one resin ty pe during the 30 days, create multiple copies of this worksheet as necessary and complete one worksheet for each resin ty pe. Do not enter data for multiple resin ty pes on a single worksheet.108054 Viny l acetate 593602 Viny l bromide 75014 Viny l chloride 75354 Viny lidene chloride (1,1-Dichloroethy lene) 1330207 Xy lenes (isomers and mixtures)2. Do not submit partial data for any day : each day

must include (at a minimum) concentration analysis results for all HAP in Table 10 to Subpart HHHHHHH of 40 CFR Part 63. 3. Complete columns 1 through 30. Enter the sample date, resin ty pe, daily resin production, number of samples composited, number of resin strippers sampled, analy sis date, lab report ID, and lab sample ID. Enter the concentration results for each HAP listed. 4. Provide the total daily production from the resin strippers samples for the ty pe of resin. If your final product is sold as a dried resin, report production on a dry basis. If your final product is sold as a wet resin report production on a wet basis. 4. Enter any

other HAP expected to be present (that are not listed in Table 10 to Subpart HHHHHHH of 40 CFRPart 63) in the table below. 5. For compounds that were not detected, indicate as such in the "Non-Detect?" column and provide the method detection limit, in ppmw, in the "Concentration (ppmw)" column. 6. Enter any

notes or additional information relevant to the sampling or analysis. 7. Refer to Attachment B of Enclosure 1 "Summary of Test Procedures, Methods, and Reporting Requirements For Resin and Process W astewater Sampling and Analysis at Poly viny l Chloride and Copoly me r (PVC) Facilities" for additional instructions and information.

**An alysis M**  **ethod Concentration**  **(ppmw) Non-Detect?**  SW -846-8015C SW -846-8015C SW -846-8315A SW -846-8315A SW -846-8270D SW -846-8270D SW -846-8270D SW -846-8270D SW -846-8270D SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B SW -846-8260B **If Other, Please Provide a Description of the Resin Type -->**

**Lab Sample ID --> Lab Report ID -->**  **Number of Resin Strippers Sampled to Obtain Composite An**  **alysis Date --> Number of Samples Composited for A**  **nalysis Total Daily Resin Production Rate (lbs of resin per day from sampled resin strippers)**  **Resin Type (suspension, dispersion, bulk, etc.) --> Sample Date -->**  1. Complete the table below for each resin ty pe produced by the facility

during the 30 days of sampling. If the facility produced more than one resin ty pe during the 30 days, create multiple copies of this worksheet as necessary and complete one worksheet for each resin ty pe. DoSW -846-8260B

SW -846-8260B EPA Method 107 SW -846-8260B SW -846-8260B2. Do not submit partial data for any day : each day

must include (at a minimum) concentration analysis results for all HAP in Table 10 to Subpart HHHHHHH of 40 CFR Part 63. 3. Complete columns 1 through 30. Enter the sample date, resin ty pe, daily resin production, number of samples composited, number of resin strippers sampled, analy sis date, lab report ID, and lab sample ID. Enter the concentration results for each HAP listed. 4. Provide the total daily production from the resin strippers samples for the ty pe of resin. If your final product is sold as a dried resin, report production on a dry basis. If your final product is sold as a wet resin report production on a wet basis. 5. For compounds that were not detected, indicate as such in the "Non-Detect?" column and provide the method detection limit, in ppmw, in the "Concentration (ppmw)" column. 7. Refer to Attachment B of Enclosure 1 "Summary of Test Procedures, Methods, and Reporting Requirements For Resin and Process W astewater Sampling and Analysis at Poly viny l Chloride and Copoly me r (PVC) Facilities" for additional instructions and information.

**Note(s) Concentration**  **(ppmw) Non-Detect?**  **Note(s) 1**  **2** 1. Complete the table below for each resin ty pe produced by the facility

during the 30 days of sampling. If the facility produced more than one resin ty pe during the 30 days, create multiple copies of this worksheet as necessary and complete one worksheet for each resin ty pe. Do7. Refer to Attachment B of Enclosure 1 "Summary of Test Procedures, Methods, and Reporting Requirements For Resin and Process W astewater Sampling and Analysis at Poly viny l Chloride and Copoly me r (PVC) Facilities" for additional instructions and information.

**Concentration (ppmw)**  **Non-Detect? Note(s)**  **Concentration (ppmw)**  **Non-Detect? 3**  1. Complete the table below for each resin ty pe produced by the facility

during the 30 days of sampling. If the facility produced more than one resin ty pe during the 30 days, create multiple copies of this worksheet as necessary and complete one worksheet for each resin ty pe. Do**Note(s) Concentration**  **(ppmw) Non-Detect?**  **Note(s) 4**  **5 Concentration** 

**(ppmw) Non-Detect?**  **Note(s) Concentration**  **(ppmw) Non-Detect?**  **6 Note(s)**  **Concentration (ppmw)**  **Non-Detect? Note(s)**  **7 8** **Concentration**

**(ppmw) Non-Detect?**  **Note(s) Concentration**  **(ppmw) Non-Detect?**  **9 Note(s)**  **Concentration (ppmw)**  **Non-Detect? Note(s)**  **10 11** **Concentration**

**(ppmw) Non-Detect?**  **Note(s) Concentration**  **(ppmw) Non-Detect?**  **12 Note(s)**  **Concentration (ppmw)**  **Non-Detect? Note(s)**  **13 14** **Concentration**

**(ppmw) Non-Detect?**  **Note(s) Concentration**  **(ppmw) Non-Detect?**  **15 Note(s)**  **Concentration (ppmw)**  **Non-Detect? Note(s)**  **16 17** **Concentration**

**(ppmw) Non-Detect?**  **Note(s) Concentration**  **(ppmw) Non-Detect?**  **18 Note(s)**  **Concentration (ppmw)**  **Non-Detect? Note(s)**  **19 20** **Concentration**

**(ppmw) Non-Detect?**  **Note(s) Concentration**  **(ppmw) Non-Detect?**  **21 Note(s)**  **Concentration (ppmw)**  **Non-Detect? Note(s)**  **22 23** **Concentration**

**(ppmw) Non-Detect?**  **Note(s) Concentration**  **(ppmw) Non-Detect?**  **24 Note(s)**  **Concentration (ppmw)**  **Non-Detect? Note(s)**  **25 26** **Concentration**

**(ppmw) Non-Detect?**  **Note(s) Concentration**  **(ppmw) Non-Detect?**  **27 Note(s)**  **Concentration (ppmw)**  **Non-Detect? Note(s)**  **28 29** **Concentration**

**(ppmw) Non-Detect?**  **Note(s) 30** **FORM H EQUIPMENT LEAKS** 

**Instructions** 1. Submit a copy of the leak detection and repair procedures for the PVC production facility and provide responses to the questions below. 2. Refer to "Enclosure 1" for additional instructions and details.
**Table 1. LDAR Program**

**Table 2. Equipment Counts**
**In Source Category**  **Subtotal of Equipment Associated**

**with Closed Vent System(s)** (Subset of count in source category)

In heavy liquid service In gas, vapor, and light liquid service Connectors

In heavy liquid service In gas, vapor, and light liquid service Agitators

In liquid service

In gas and vapor service Pressure Relief Devices

Open ended valves and lines Sampling connection systems Compressors Instrumentation systems Valves

In heavy liquid service

In light liquid service Pumps 40 CFR Part 61, Subpart V Other Federal LDAR Regulation Specify: State LDAR Regulation Specify: Provide the total cost to your facility for conducting the LDAR program at this process unit in 2013:

**Equipment**

In heavy liquid service In gas, vapor, and light liquid service Is there an equipment leak detection and repair (LDAR) program for all equipment at your facility included in the source category? If "No," how are equipment leaks detected and repaired?

If "Yes," is the equipment subject to the requirements of: 40 CFR Part 63, Subpart UU

Page 1 of 1 **DRAFT** PVC Section 114 Survey Part 1 06/23/2009**FORM K-1**

**TA NKS, VESSELS A**  **ND PORTA BLE CONTA**  **INERS USED FOR FEEDSTOCK STORA GE, PRODUCT STORA** **GE, VENT GA S STORA** **GE, HOLDING, A ND WA**  **STEWA TER** 
**Instructions** 1. Complete this form for 2013 only. 2. Provide copies of estimation worksheets and any other relevant documentation. 3. Complete this form for individual equipment, including equipment that is not assigned an equipment ID (e.g., portable containers). 4. Do not include gas holders on this form. Complete Form K-2 for gas holders. 4. Refer to "Enclosure 1" for additional instructions and details.

**Table 1.**

**Table 2. Vapor Pressure**  **Total Emissions** (in H2O) Minimum Maximum Average **(pounds)** (select HAP) (select HAP) (select HAP) (select HAP) (select HAP) (select HAP) (select HAP) (select HAP) (select HAP) (select HAP) (select HAP) If Other, please specify, being as descriptive as possible: Source Process Equipment ID (if applicable): Equipment Description: If not provided in the equipment description above, describe the tank, vessel, or container and indicate (if applicable) if the tank is a fixed, floating internal, or floating external roof. Select the purpose of the equipment:

If Yes, How Are The Emissions Controlled?

**Concentration (ppmvd @ 3% O2)** How is the HAP Concentration Determined? Are HAP Emissions Controlled?

**Individual HA P Present**  Source Equipment Type:

Number of turnovers: Equipment volume (m 3 ):

**Notes** Storage Temperature (°F)

Page 1 of 1 **DRAFT** PVC Section 114 Survey Part 2 06/23/2009**FORM L STARTUP, SHUTDOWN, AND MALFUNCTION** 
**Instructions** 1. Complete this form for 2013 only. 2. Submit with your response to this survey, copies of all records of emissions during periods of process startup, shutdown, and malfunctions for 2013 only. 3. Refer to "Enclosure 1" for additional instructions and details.

For a malfunction:

(select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) (select HAP) (pounds) **Total Emissions During Startup, Shutdown, or Malfunction Event**  We re all of the emissions control devices operating for the entire duration of the startup, shutdown, or malfunction event? Startup, Shutdown or Malfunction?

If startup or shutdown, what was the duration (hours):

Provide a short description of the malfunction and the circumstances:

If No, which control devices were not operating (Control Equipment ID), for how long, and why:

We re permitted emissions limits exceeded?

Provide a description of the procedures used to alert the owner/operator that the malfunction occurred. If the malfunction resulted in a release of emissions, describe any indicators used to signal and/or measure the release. Is there a written startup, shutdown and/or malfunction plan for the process unit? Provide a description of the systems and equipment in place that function to notify operators that a malfunction **is occurring**

.

Applicable standard or regulation: Describe what actions, if any, were taken to minimize emissions to the atmosphere:

Page 1 of 1 **DRAFT** PVC Section 114 Survey Part 1 06/23/2009