MEMORANDUM 

To: Jim Eddinger, U.S. Environmental Protection Agency, OAQPS (D243-01) 

From: Susan McClutchey and Graham Gibson, ERG 

Date: April 2010 

Subject: Data Dictionary for Boiler, Process Heater, and Other Combustion Unit 

Survey Databases 

1.0 INTRODUCTION 

This memo serves as a Data Element Dictionary for the databases containing 

responses from boilers and in-direct fired process heaters at major and area sources of 

Hazardous Air Pollutant (HAP) emissions. Reponses to the 2008 Combustion Survey 

and 2009 Boiler and Process Heater Test Plan are included in the databases1,2. 

Combustion unit and facility level data are located in the database entitled Survey 

Database containing Results of the 2008 Questionnaire for Boilers, Process Heaters, & 

Other Combustion Units (ICR No. 2286.01)3. All emission test, emission monitoring, 

fuel analysis, and data reported in the 2009 Test Plan are located in the database entitled 

Emissions Database for Boilers and Process Heaters Containing Stack Test, CEM, & 

Fuel Analysis Data Reported under ICR No. 2286.01 & ICR No. 2286.03 (version 5)4. 

Data from facilities responding to the survey have since notified EPA that the entire 

facility or a particular unit within a facility are or will be permanently shut down prior to 

the compliance date for the NESHAP, data pertaining to these facilities or units were 

excluded from these databases. This memo documents the database structure and format 

and describes the information contained in each database. 

In order to analyze the survey response data, it was necessary to standardize some 

fields to ensure uniformity in calculating emissions and costs. The standardization 

process involved retaining the original survey response data while adding new fields in 

which the original data were manipulated as needed. Appendices A and B note those 
fields added to the raw survey response data during the standardization process for each 

database. The processes used to standardize survey response data are described in 

another memorandum5

. 

This memorandum is divided into the following sections: 

1.0 Introduction 

2.0 Database Description 

3.0 References 

 Appendix A: Mapping of Database Table Fields in the Survey Results Database 

 Appendix B: Mapping of Database Table Fields in the Emissions Database 

 Appendix C: 2008 Questionnaire Excel Templates 

Appendix D: 2009 Test Plan Excel Templates 
2.0 DATABASE DESCRIPTION 

2.1 File Format 

A computer program was developed to convert data submitted in seven separate 

Microsoft ® Excel survey template files into a Microsoft ®Access database. The Excel 

templates used to report data in the 2008 Questionnaire are shown in Appendix C. The 

Excel templates used to report data in the 2009 Test Plan are shown in Appendix D. Two 

databases were created, one to hold facility and unit level information and the other to 

hold emissions test, emissions monitoring, and fuel analysis data. The databases contain 

23 separate data tables to summarize information on the facility, combustion unit design 

and operations, fuels and materials combusted in the unit, air pollution control devices, 

stack configurations, emission test data, continuous emissions monitoring (CEM) data, 

fuel analysis data, good combustion practices, and permitted and regulatory limits data. 

Within each of the 23 data tables, each record is assigned to a unique identifier 

called a Facility ID. The Facility ID begins with a two-letter state abbreviation and an 

abbreviated facility name (i.e., AKDoyon). This identifier relates each record to a unique 

facility. 

Twenty of the data tables contain a second unique identifier called a Combustor 

ID or Unit ID. The Combustor ID was provided by each respondent and this identifier 

relates each record to a unique combustion unit in the database. Some of the Combustor 

ID identifiers represent multiple combustion units. In these cases, the records are 

representing data from more than one combustion unit, such as units at common stack or 

small gas units that were reported in aggregate. 

The remaining two data tables do not contain data aggregated at the unit-level. 

Records within the Data: Fuel Analysis and Data: Fuel Analysis Background tables are 

provided at the facility level and they are assigned to a unique Facility ID. 

2.2 Database Table Structure 

The tables providing basic unit and facility level information such as unit design 

and operation, and materials combusted in the unit are located in a Survey Results 

Database. The fields within each table in this database are described in detail in 
Appendix A. The tables providing emissions test, emissions monitoring, and fuel 

analysis data are located in a Consolidated Emissions Database. The fields within each 

table in this database are described in detail in Appendix B. 

CEMS data are provided in two data tables. These data summarize information 

collected from the “CEMSSpreadsheet.xls” and “Small Gas CEMS Spreadsheet.xls” 

Microsoft ® Excel template files from the 2008 Combustion Survey and the 

“CEMSTemplate.xls” Microsoft ® Excel template file from the 2009 Test Plan. 

 Data: CEMS Table: This table contains 30 days of reported CEM data for CO, 

SO2, NOx, and Particulate Matter for unique combinations of Facility and 

Combustor IDs. Additionally, this table contains the single highest opacity 

reading within the 30 day period. This data table is located in the Emissions 

Database and includes data from both the 2008 Combustion Survey and 2009 Test 

Plan. 

 Data: CEMS Backgrnd Table: This table gives background information for the 

CEM emissions, including fuel, operating rate, and controls. Records within this 

table are related to the Data: CEMS Table using the FacilityID, CombustorID and 

Pollutant Name data fields. This data table is located in the Survey Results 

Database and includes data from both the 2008 Combustion Survey and 2009 Test 

Plan. 

Results of Emissions Test Data are provided in the following three data tables. 

These data summarize information collected from the “EmissionTestSpreadsheet.xls” and 

“Small Gas Emission Test Spreadsheet.xls” Microsoft ® Excel template files from the 

2008 combustion survey, and the “EmissionsTestTemplate_BLR.xls” Microsoft ® Excel 

template file from the 2009 Test Plan. Records within the three emission test tables are 

related using the Facility ID, Combustor ID, Test ID, and Source Tab data fields. 

 Data: EmissionsTest Table: This table contains emission test data including 

pollutant names, reported emission values and corresponding units of measure, as 

well as standardized emission concentrations and emission rates to consistent 

units of measure. This table also includes information on test methods used for 

each pollutant, whether the test was conducted upstream or downstream of the 

control device, and any reported notes about the test. This data table is located in 

the Emissions Database and includes data from both the 2008 Combustion Survey 

and 2009 Test Plan. 
 Data: EmissionsTest Background Info Table: This table contains operating 

parameter and exhaust data corresponding to each test run of the reported 

emission test results in the Data: EmissionsTest Table. The parameters included 

in this table are steam output rate and total heat input value. Total heat input rates 

were reported in units of mmBtu/hr. If emission test results were reported in units 

of concentration, this table also contains exhaust characteristics including: 

flowrate, basis of flowrate measurement (wet or dry), temperature, and moisture 

content. If the reported emission concentrations were adjusted to certain O2 or 

CO2 levels, these adjustments were also noted in this table. This data table is 

located in the Survey Results Database and includes data from both the 2008 

Combustion Survey and 2009 Test Plan. 

 Data: EmissionsTest Fuel Data Table: This table contains data on types of fuels 

and fuel input rates used during each reported emission test. Fuel input rates have 

been standardized to units of mmBtu/hr, when possible. This data table is located 

in the Survey Results Database and includes data from both the 2008 Combustion 

Survey and 2009 Test Plan. 

 Data: Emissions Test and CEMS Installed Table: The table contains StartupFuel 

and Fuel data for individual combustion units, as well as reporting the availability 

of emission tests for the unit. The table also lists the pollutants for which CEM is 

installed for the unit, as well as details about the regulatory requirements for 

CEM, and ability to record or save the data gathered. This data table is located in 

the Survey Results Database and includes data from the 2008 Combustion Survey 

only. 

 Data: FuelAnalysis Table: This table provides the analysis of any fuel (excluding 

natural gas, propane, liquefied petroleum gas and refinery gas) combusted in units 

included in the database. This table links to other database tables using Facility 

ID, CombustorID, Control Device and SampleID. This data table is located in the 

Emissions Database and includes data from both the 2008 Combustion Survey 

and 2009 Test Plan. 

 Data: Total Metals Emissions Table: This table contains calculated total metals 

emission data from the Data: EmissionsTest table for a unique emission test from 

a specific Facility ID and Combustor ID combination. This table is located in the 

Emissions Database. The methods used to develop this table are detailed in 

another memorandum5

. 

 Data: Total PCDD/PCDF Emissions (TEQ & Total Mass) Table: This table 

contains calculated and reported total mass and toxic equivalent (TEQ) 

dioxin/furan emissions data from the Data: EmissionsTest table for a unique 

emission test from a specific Facility ID and Combustor ID combination. This 

table is located in the Emissions Database. The methods used to develop this 

table are detailed in another memorandum5

. 
All of the permitted and regulatory emission limits reported in the 

“PermittedandRegulatoryLimits.xls” combustion survey Microsoft ® Excel template file 

are contained in the following data table: 

 Data: Regulatory and Permit Limits Table: This table lists permitted emission 

limits reported for any of the combustion units in the database. Also noted is the 

fuel associated with the limit, and oxygen or carbon dioxide dilutions associated 

with the limit. Each record in this database represents a unique combination of 

FacilityID, UnitID and Pollutant. The records in this table are related to records 

in other tables using the FacilityID and CombustorID fields. This data table is 

located in the Survey Results Database and includes data from the 2008 

Combustion Survey only. 

All of the characteristics reported in the “AnswerKey.xls” combustion survey 

Microsoft ® Excel template file are contained in the following eight data tables. Six of 

these tables are related using the Facility ID and CombustorID data fields. The 

remaining two tables are related using the Facility ID. The tables are discussed in the 

order the data was reported in the “AnswerKey.xls” spreadsheet template. 

 Data: Facility Table: This table contains facility information for all facilities with 

combustion units represented in the database. Physical address, contact 

information, designation of major or area source of HAP, and basic facility 

economic data are included in the table. The FacilityID field is the primary key, 

which links the table to others in the database. This data table is located in the 

Emissions and Survey Results Databases and includes data from the 2008 

Combustion Survey only. 

 Data: GCP and Combustion Controls Table: This table records good combustion 

practices and combustion control devices associated with combustion units 

included in the database. It links to other tables using the FacilityID and UnitID 

fields. This table includes data reported on small gas-fired boilers and process 

heaters reported in section II.A of the AnswerKey.xls template spreadsheet, as 

well as on larger units reported in section II-B.3b-4 of the template spreadsheet. 

The field SourceTab provides an indication of what section of the template 

spreadsheet each data record came from. This data table is located in the Survey 

Results Database and includes data from the 2008 Combustion Survey only. 

 Data: Unit Design/Operation Table: This table includes all the available details 

about the design and operating parameters for the combustion units contained in 

the database. This includes the size, capacity, fuel, applicability of New Source 

Performance Standards, the primary and additional uses of the unit and the unit 

design. Records within this table are related to records in other tables using the 
FacilityID and UnitID fields. Because not all respondents answered all sections 

of the AnswerKey.xls template spreadsheet, this table was considered to be the 

most complete inventory of units that were required to answer Section II.B of the 

template spreadsheet. This data table is located in the Survey Results Database 

and includes data from the 2008 Combustion Survey only. 

 Data: Control Device Table: This table contains details about add-on air 

pollution control devices associated with combustion units in the Data: Unit 

Design/Operation Table. Additional information contained in the table includes 

control device upgrade information, and the presence of continuous parameter 

monitoring systems. The records in this table are related to other tables using the 

FacilityID and CombustorID fields. This data table is located in the Survey 

Results Database and includes data from the 2008 Combustion Survey only. 

 Data: Stack Table: This table gives details about the stack configuration for each 

combustion unit responding to Section II.B of the survey. It shows which units 

utilize a single stack, and which use a common stack or multiple stacks. The table 

links to other tables with the Facility ID and UnitID fields. This data table is 

located in the Survey Results Database and includes data from the 2008 

Combustion Survey only. 

 Data: Materials Combusted Table: This table contains information about the 

fuels and other materials combusted in each combustion unit listed in the 

database. The data include related startup fuels, hours of operation, heat input, 

and permit limits associated with each type of fuel or material. Each record in 

this database represents a unique combination of FacilityID, UnitID, 

CommonStartupFuel, CommonFuel, and CommonNRC fuel. Records within this 

table can be related to other unit and fuel-specific data using any of the three 

common fuel fields and the Facility ID. This data table is located in the Survey 

Results Database and includes data from the 2008 Combustion Survey only. 

 Data: Emissions Test And CEMS Installed Table: This table contains information 

about whether or not an emission test was conducted, the location of the emission 

test, and whether or not continuous emission monitors or THC monitors are 

installed on the unit. Each record in this database represents a unique 

combination of FacilityID and UnitID. This data table is located in the Survey 

Results Database and includes data from the 2008 Combustion Survey only. 

 Data: Non-Fossil Fuels Table: This table contains information about units 

burning non-fossil fuels. It includes an identification of the non-fossil fuel, an 

alternative disposal method if the material could not be burned, and compliance 

costs associated with a Section 129 rule if the non-fossil fuel would cause a unit 

to be regulated as a Commercial Industrial Solid Waste Incinerator. Each record 

in this database represents a unique combination of FacilityID, UnitID and 

NonFossilFuel. Records within this table can be related to other unit and fuelspecific data using the NonFossilFuel field and the Facility ID. This data table is 
located in the Survey Results Database and includes data from the 2008 

Combustion Survey only. 

 Data: FuelAnalysis Background Information Table: This table lists all nongaseous fuels or material combusted at each facility in the database. Also 

included is information on the origin of the fuel/material and an indication of 

whether or not a fuel analysis was reported by the survey respondent. The table 

links to the rest of the database using the FacilityID field. This data table is 

located in the Survey Results Database and includes data from the 2008 

Combustion Survey only. 

The 2009 Test Plan requested some additional information that was not reported 

in the 2008 Combustion Survey. This additional data consisted of 30-day process, fuel 

usage, control device operation, and hourly emissions monitoring data. For each 

combustion unit that reported data as a part of this test plan, the identical Facility ID and 

Unit ID used from the 2008 Combustion Survey corresponding to that same unit was 

used in each of the following tables. Thirty-day process, fuel, and control information 

were reported in the “30DayProcessInformationTemplate.xls” Microsoft ® Excel 

template file. Thirty-day monitoring data was reported in the 

“CO&HCMonitoringTemplate.xls” Microsoft ® Excel template file. 

 Data: 30day Control Table: This table provides operating data for any add-on air 

pollution control devices associated with combustion units in the Data: Unit 

Design/Operation Table that were a part of the 2009 Test Plan. Control device 

data included operating parameters such as pressure drops and voltages. 

Operations data were provided for a 30-day interval. This data table is located in 

the Emissions Database and includes data from the 2009 Test Plan only. 

 Data: 30day Fuel Table: This table provides data on fuels combusted in 

combustion units in the Data: Unit Design/Operation Table that were a part of the 

2009 Test Plan. Fuel data included the type of fuel and the corresponding heat 

input. Fuel data were provided for a 30-day interval. This data table is located in 

the Emissions Database and includes data from the 2009 Test Plan only. 

 Data: 30day Process Table: This table provides process data for combustion 

units in the Data: Unit Design/Operation Table that were a part of the 2009 Test 

Plan. Process data included physical properties of process exhaust, such as 

effluent flowrates and temperatures. Process data were provided for a 30-day 

interval. This data table is located in the Emissions Database and includes data 

from the 2009 Test Plan only. 
 Data: CO and THC CEMS Table: This table provides 30-day emissions 

monitoring data for carbon monoxide (CO), THC, methane, and non-methane 

hydrocarbons for unique combinations of Facility and Combustor IDs. This data 

differs from the monitoring data reported in the 2008 Combustion Survey in that 

data is reported in hourly increments over a span of 30 days, rather than just a 

single daily average. This data table is located in the Emissions Database and 

includes data from the 2009 Test Plan only. 

 Data: CO and THC CEMS Backgrnd Table: This table gives background 

information for the 30-day emissions monitoring, including fuel, operating rate, 

and controls. Records within this table are related to the Data: CEMS Table using 

the FacilityID and CombustorID data fields. Records within this table are related 

to the Data: CO and THC CEMS Table using the FacilityID, CombustorID and 

Source Tab data fields. This data table is located in the Emissions Database and 

includes data from the 2009 Test Plan only. 

2.3 LOOKUP and Inventory Tables 

Lookup tables were generated to aid in the standardization of data reported in the 

2008 Combustion Survey and 2009 Test Plan. The inventory table is a list of each unique 

boiler and process heater at a major source of HAP for which data was reported to the 

survey. The data in these tables is a combination of reported and standardized data. The 

fields in these tables are not mapped in an Appendix to this document since each table is 

detailed in other memoranda5,6. 

 LOOKUP: Common Fuels Table: This table provides a standard naming 

convention for all fuels reported in the databases. This table is located in the 

Survey Results Database. The methods used to develop this table are discussed in 

another memorandum5

. 

 LOOKUP: Control Devices Table: This table provides a standard naming 

convention for all control devices reported in the databases. This table is located 

in the Survey Results Database. The methods used to develop this table are 

discussed in another memorandum5

. 

 LOOKUP: Design Capacity Conversions Table: This table provides the 

equations used to standardize design capacities and other fuel inputs. This table is 

located in the Survey Results Database. The methods used to develop this table 

are discussed in another memorandum5

. 

 LOOKUP: F-Factors Table: This table provides an F-Factor for each fuel 

reported in the database. F-factors were not available for all reported fuels. This 
table is located in the Survey Results Database. The methods used to develop this 

table are discussed in another memorandum5

. 

 LOOKUP: Fuel Input Conversions/HHVs Table: This table provides the 

equations used to standardize higher heating values into a form suitable for fuel 

analysis conversions. This table is located in the Survey Results Database. The 

methods used to develop this table are discussed in another memorandum5

. 

 LOOKUP: Pollutant Molecular Weights Table: This table contains the molecular 

weights for pollutants for which emissions data were reported. Molecular weights 

were necessary for some emission conversions. This table is located in the 

Survey Results Database. The methods used to develop this table are discussed in 

another memorandum5

. 

 LOOKUP: Toxic Equivalency Factors Table: This table contains the toxic 

equivalency factors used to standardize toxic equivalent dioxin/furan emissions. 

This table is located in the Emissions Database. The methods used to develop this 

table are discussed in another memorandum5

. 

 LOOKUP: Unit Conversions Table: This table contains the equations used to 

standardize all emissions data. This table is located in the Survey Results 

Database. The methods used to develop this table are discussed in another 

memorandum5. 

 Inventory: Major Source Boilers & Process Heaters Table: This table contains an 

inventory of operational major source boilers and process heaters that initially 

reported data in the 2008 Questionnaire. This table is located in both the Survey 

Results and Emissions Databases. The methods used to develop this database are 

detailed in another memorandum6. 

3.0 REFERENCES 

1. U.S. Environmental Protection Agency. 2008 Questionnaire for Boilers, Process 

Heaters, Incinerators and Other Combustion Units (ICR No. 2286.01, OMB 

Control No. 2060-0616, EPA Form No. 5900-122) 

2. U.S. Environmental Protection Agency. 2009 Test Plan for Boilers and Process 

Heaters ICR No. 2286.03, OMB Control No. 2060-0616, EPA Form No. 5900-

122 

3. Survey Database containing Results of the 2008 Questionnaire for Boilers, 

Process Heaters, & Other Combustion Units (ICR No. 2286.01). 
4. Emissions Database for Boilers and Process Heaters Containing Stack Test, CEM, 

& Fuel Analysis Data Reported under ICR No. 2286.01 & ICR No. 2286.03 

(version 5). 

5. Gibson, G., ERG. Standardization of Reported Data from the Questionnaire for 

Boilers, Process Heaters, Incinerators and Other Combustion Units, April 2010. 

6. Gibson, G. and A. Singleton, ERG. Development of Baseline Emission Factors 

for Boilers and Process Heaters at Commercial, Industrial and Institutional 

Facilities. April 2010. 
Appendix A-1: Field Mapping for the Data: CEMS Backgrnd Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

Source This field identifies the source of the data as CEMS or SmallGasCEMS.

Pollutant This field identifies the pollutant being monitored as CO, NOx, SO2, Opacity, or PM.TypControl This field contains the Control Device Configuration for 30-day CEMS period (drop-down menu provided)*Standardized TypControl This is a post-submittal field which standardizes the terms used for pollution control devices.

TypOpRate This field contains the typical operating rate during the 30-day CEMS period (MMBtu/hr)

UpsetsDuringTypOperations This field gives space for a description of any operational upsets during 30-day CEMS period.TypFuel This field gives the typical fuel mix utilized during 30-day CEMS period*Common Fuel This post-submittal field shows the standardized fuel type for TypFuel.F-Factor This post-submittal field contains the F-Factor needed to convert CO or PM to standard units.TypFuelRate This field contains the typical fuel rate during the CEMS period.TypFuelRateUnits This field gives the units for typical fuel rate.MaxFuel This field gives the fuel Maximum 6-minute average.*Common MaxFuel This post-submittal field shows the standardized fuel type for MaxFuel.MaxFuelRate This field gives the fuel rate at Maximum 6-minute average.MaxFuelRateUnits This field gives the units for the fuel rate at Maximum 6-minute average.

UpsetsDuringMaxOperations This field gives space for a description of any operational upsets during maximum 6-minute period.MaxControl This field gives the control device configuration used during the maximum 6-minute average.MaxOpRate This field provides the operating rate during the maximum 6-minute average.Original CombustorID This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 1 of 29
Appendix A-2: Field Mapping for the Data: Control Device Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.UnitID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

ControlDevice This field indicates the presense of an add-on pollution control device.*Standardized ControlDevice This is a post-submittal field which standardizes the terms used for pollution control devices.

YearInstalled This field gives the installation year of control device.Upgrade This field indicates if the control device has been upgraded. (Yes=True/No=False)

UpgradeCompliance This field indicates if the control device was upgraded to comply with 40 CFR 63 Subpart DDDDD. (Yes=True/No=False) RemovedAdded If the control device was upgraded, this field indicates if the original was removed or upgraded (Yes=True/No=False)PriorDevice If upgraded, this field identifies the prior device. (drop-down menu provided) *Standardized PriorDevice This is a post-submittal field which standardizes the terms used for the pollution control devices used prior to current contro

upgradedate_currentdevice This field gives the date of upgrade to current device.upgradedate_piordevice This field gives the date of original device installation (mm/yyyy).

CommonControl This field indicates if the control device is used for multiple combustion units? (Yes=True)CommonControlUnits This field gives the control units utilizing the control device, if yes is answered in the CommonControl field.CPMS_None This field indicates if there is No Continuous Parameter Monitoring System (CPMS).CPMS_PressureDrop This field gives the CPMS measures pressure drop.CPMS_FlowRate This field gives the CPMS measures flowrate.CPMS_Voltage This field gives the CPMS Voltage measurement.

CPMS_Other This field indicates if there is another CPMS parameter being measured.CPMS_OtherExp This field allows space to explain the CPMS parameter referred to in the CPMS_Other field.

Original UnitID This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 2 of 29
Appendix A-3: Field Mapping for the Data: Emissions Test And CEMS Installed Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.UnitID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

StartupFuel This field shows the fuel used to start the unit.Fuel Shows the main fuel burned in the combustion unit.EmissionTest This field indicates the availability of an emission test. (Yes=True/No=False)

EmissionTestLoc This field indications the location where available emission test occurred.SO2_Test This field indicates the presense of an SO2 CEM. (Yes=True/No=False)SO2_Monitor This field indicates whether or not SO2 is monitored for Regulatory Purposes. (Yes=True/No=False)SO2_Record This field indicates if the SO2 CEMS is recorded. (Yes=True/No=False)SO2_Save This field indicates if the SO2 CEMS data are saved (Yes=True/No=False)NOx_Test This field indicates if there is a NOx CEM installed. (Yes=True/No=False)NOx_Monitor This field indicates if NOx is monitored for Regulatory Purposes (Yes=True/No=False)NOx_Record This field indicates if the NOx CEMS data are recorded. (Yes=True/No=False)NOx_Save This field indicates if the NOx CEMS data are saved. (Yes=True/No=False)CO_Test This field indicates the presense of an CO CEM. (Yes=True/No=False)CO_Monitor This field indicates if CO is monitored for Regulatory Purposes. (Yes=True/No=False)CO_Record This field indicates if the CO CEMS data are recorded? (Yes=True/No=False)CO_Save This field indicates if the CO CEMS data are saved? (Yes=True/No=False)O2_Test This field indicates the presense of an O2 CEM installed? (Yes=True/No=False)O2_Monitor This field indicates if the O2 is monitored for Regulatory Purposes (Yes=True/No=False)O2_Record This field indicates if O2 CEMS data are recorded? (Yes=True/No=False)O2_Save This field indicates that O2 CEMS data are saved? (Yes=True/No=False)PM_Test This field indicates the presense of PM CEM. (Yes=True/No=False) 

PM_Monitor This field indicates if PM is monitored for regulatory purposes. (Yes=True/No=False)

PM_Record This field indicates if PM CEMS data are recorded? (Yes=True/No=False)PM_Save This field indicates if PM CEMS data are saved? (Yes=True/No=False) VOC_Test This field indicates the presense of a VOC CEM? (Yes=True/No=False)VOC_Monitor This field states if VOC is monitored for regulatory purposes. (Yes=True/No=False) 

VOC_Record This field indicates if the VOC CEMS data are recorded? (Yes=True/No=False) VOC_Save This field indicates if the VOC CEMS data are saved? (Yes=True/No=False)

Original UnitID This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.

Page 3 of 29
Appendix A-4: Field Mapping for the Data: EmissionsTest Background Info Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID_common

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

ControlDevice This identifier lists any add-on Pollution Control Device.

*Standardized ControlDevice This is a post-submittal field which standardizes the terms used for pollution control devices.

TestID This field contains an identifying sample number for tracking emission test results.TestDate_common This field shows the date of the emission test.Steam This field reports the steam output rate from the combustion unit at the time of the emission test.SteamUnit This field gives the steam output rate unit.SteamUnitOther This field provides space for steam output rate alternative unit information. Should correspond to an "Other" response in th

*Standardized Steam This post-submittal field converts steam output to standard units.*Standardized Steam Unit This post-submittal field shows the standardized steam output unit (1000 lb/hr)

SteamLocation This field indicates if testing was done either upstream or downstream of control device.SteamNote This field provides space for additional information on steam output.THI_Value This value gives the total heat input.THI_Unit This field reports the unit for the total heat input.*Standardized THI_Value This post-submittal field converts total heat input to standard units.

*Standardized THI_Unit This post-submittal field shows the standardized THI unit. (mmBtu/hr)THI_UnitOther This field provides space for total heat input alternative unit information. Should correspond to an "Other" response n the "

THI_Location This field Indicates if testing is done upstream or downstream or control device.THI_Note This field provides space for additional total heat input information.DryOrWet This field indicates the basis on which testing is measured, wet or dry.DryOrWetNote This field provides space for additional basis information.CO2_Value This field gives the CO2 emission value for the Test ID.CO2_Unit This field provides the unit related to the CO2 pollutant value.CO2_Method This field idicates the CO2 Test Method used to determine the CO2 value.CO2_Location This field indicates if CO2 sample taken before or after control device.CO2_Note This field provides space for additional CO2 emission informationO2_Value This field gives the O2 emission value for the Test ID.*Standardized O2_Value This field is a post-submittal field converting O2 emissions to a numeric value with standard units.

O2_Unit This field provides the unit related to the O2 emission value.O2_Method This field indicates the O2 Test Method used to determine the O2 value.O2_Location This field indicates if the O2 sample was taken before or after control device.O2_Note This field provides space for additional O2 Information.Moisture This field gives the percent of moisture in the exhaust.*Standardized_Moisture This post-submittal field converts the moisture value to standardized units of percent.MoistureNote This field provides space for additional moisture information.ExhaustFlow This field gives the exhaust flow rate.*Standardized_ExhaustFlow This post-submittal field converts the exhaust flowrate to a standard unit.

Page 4 of 29
Appendix A-4: Field Mapping for the Data: EmissionsTest Background Info Table

Field Name Description*Standardized_ExhaustFlowUnit This post-submittal field shows the standardized unit for the exhaust flowrate (dscfm).

ExhaustFlowUnit This field gives the original exhaust flowrate units.ExhaustFlowNote This field provides space for additional exhaust flowrate information.ExhaustTemp This field gives the exhaust temperature.*Standardized_ExhaustTemp This post-submittal field converts the exhaust temperature to a standard unit.*Standardized_ExhaustTempUnit This post-submittal field shows the standardized exhaust temp unit (F).ExhaustTempUnit This field provides the original unit for Exhaust Temperature

ExhaustTempNote This field provides space for additional exhaust temperature information.SourceTab This field identifies the EmissionTestSprdsheet tab of the 2008 Combustion Survey Emission Test in which the data originaOriginal CombustorID_common This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 5 of 29
Appendix A-5: Field Mapping for the Data: EmissionsTest Fuel Data Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID_common

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

TestID This field contains an identifying sample number for tracking emission test results.TestDate_common This field shows the date of the emission test.FuelParameter_Type This field identifies the parameter type being recorded.*Common Fuel This post-submittal field shows the standardized fuel name.FuelParameter_TypeOther This field identifies the other parameter type.

FuelParameter_Value This field gives the numerical value of the parameter type being detailed.

FuelParameter_Unit This field provides the unit for the parameter value chosen from menu.

*Standardized Fuel Rate This post-submittal field shows the fuel rate converted to standard units.*Standardized Fuel Rate Units This post-submittal field shows the standard fuel rate units. (Mbtu/hr)

FuelParameter_UnitOther This field provides alternative parameter value unit information. Should correspond to an "Other" response in the "FuelParFuelParameter_Method This field provides the method used to determine the parameter value.FuelParameter_Note The field provides space for additional parameter information.SourceTab This field identifies the EmissionTestSprdsheet tab of the 2008 Combustion Survey Emission Test in which the data originaOriginal CombustorID_common This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 6 of 29
Appendix A-6: Field Mapping for the Data: Facility Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.Facility Name This field gives the name of the facility responding to the survey.2a_Phys_Address This field gives the facility's physical street address.2b_Phys_City This field gives the facility's physical city.2c_Phys_State This field gives the facility's physical state.2d_Phys_Zip This field gives the facility's physical zip code.2e_Phys_County This field gives the facility's physical county.3a_ContactName This field provides the first and last name of facility contact3b_ContactTitle This field provides the professional title of contact person.3c_Telephone This field provides the contact person phone number with extension.3d_Fax This field lists the fax number for the contact person.

3e_E-mail This field gives the e-mail address for contact person.4_FacilityLegalName

This field contains the legal name of the facility, if different form the name given in the "Facility Name" field. If the field is lesubmittal to Facility ID.

5_AffectedSector This field indicates if the affected sector is public, private, or not-for-profit.6_MajororArea This field indicates if the facility is major source of HAPs. (True=Major/False=Area)

7a1_NumberCompanyEmployees This field provides the number of employees in the company. This field only needs to be answered if the affected sector is 7a2_NumberFacilityEmployees This field provides the number of employees at the facility. This field only needs to be answered if the affected sector is pr7b1_Population This field gives the population of local public entity. This field only needs to be answered if the affected sector is public8_Small Entity This field answers the question "Is this facility a small entity?" with Yes, No, or Unknown.9_NAICS This field gives the 3-digit NAICS.

Page 7 of 29
Appendix A-7: Field Mapping for the Data: FuelAnalysis Background Information Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.Fuel_Material This field lists the fuel or material for which analysis is included.*Common Fuel This post-submittal field shows the standardized fuel name.FM_originate This field indicates the origin of fuel or material as either on-site or off-site.FM_analysisavailable This field indicates the availability of fuel analysis. (True=available)* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 8 of 29
Appendix A-8: Field Mapping for the Data: GCP and CombustionControls Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.UnitID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

AirTrimControl This field describes the Air Trim Control - Oxygen, Carbon Monoxide, Neither or UnknownUnitNumber This field gives the number of units associated with the UnitID.ScheduledTuneUp This field reports if tune ups are scheduled. (True=Yes/False=No)ScheduledTuneUp_freq This field reports the frequency of tune-ups.FuelSystemInspectClean This field reports if the fuel system is subject to inspection/cleaning. (True=Yes/False=No)FuelSystemInspectClean_freq This field reports the frequency of Fuel System Inspection/Cleaning.SurfaceInspectCleanRecondition This field reports if surface inspection/cleaning/reconditioning is done. (True=Yes/False=No)SurfaceInspectCleanRecondition_freq This field reports the frequency of Surface Inspection/Cleaning/Reconditioning.CkElectricalandCombCtrl This field reports if electrical and combustion control checks are done. (True=Yes/False=No)CkElectricalandCombCtrl_freq This field reports the frequency of Electrical and Combustion Control Checks.TestExhaustGases This field reports if there is testing of exhaust gases. (True=Yes/False=No)TestExhaustGases_freq This field reports the frequency of Exhaust Gas Testing.COlevelAdjustment This field reports if CO levels are adjusted. (True=Yes/False=No)ValveInspection This field reports if valves are inspected. (True=Yes/False=No)ValveInspection_freq This field reports the frequency of Valve Inspections.RefractoryInspection This field reports if refractory inspections are performed. (True=Yes/False=No)RefractoryInspection_freq This field reports the frequency of Refractory Inspection.FanCleanInspect This field reports fan cleaning/inspection. (True=Yes/False=No)FanCleanInspect_freq This field reports the frequency of Fan Cleaning/Inspection.FeedWaterInspect This field reports the inspection of feed water. (True=Yes/False=No)FeedWaterInspect_freq This field reports the frequency of Feed Water Inspection.GCP_OpTrainRecord This field reports if a Good Combustion Practices Operation Training Record is kept. (True=Yes/False=No)GCP_OpTrainRecord_freq This field reports the frequency of Good Combustion Practices Operation Training Recordkeeping.GCP_MaintenanceKnowledge This field reports the use of Good Combustion Practices Maintenance Knowledge. (True=Yes/False=No)GCP_MaintenanceKnowledge_freq This field reports the frequency of utilizing GCP Maintenance Knowledge.GCP_MaintenancePractices This field reports the us of Good Combustion Practices Maintenance Practices. (True=Yes/False=No)GCP_MaintenancePractices_freq This field reports the frequency with which GCP Maintenance Practices are used.GCP_FuelAirRatio This field reports the use of Good Combustion Practices Fuel/Air Ratios. (True=Yes/False=No)GCP_FuelAirRatio_freq This field reports the frequency with which GCP Fuel/Air Ratio is checked.GCP_AutoO2andCOtrimcontrols This field reports the use of Good Combustion Practices Auto O2 and CO trim controls. (True=Yes/False=No)GCP_FurnaceResTimeandTemp This field reports the use of Good Combustion Practices Furnace Residence Time and Temperature. (True=Yes/False=NoGCP_FurnaceResTimeandTemp_freq This field reports the frequency with which GCP Furnace Residence Time and Temperature are checked.GCP_FuelQualandHandling This field reports the use of Good Combustion Practices Fuel Quality and Handling. (True=Yes/False=No)GCP_FuelQualandHandling_freq This field reports the frequency of using GCP Fuel Quality and Handling procedures.

Page 9 of 29
Appendix A-8: Field Mapping for the Data: GCP and CombustionControls Table

Field Name DescriptionGCP_LiquidAtomization This field reports the use of Good Combustion Practices Proper Liquid Atomization. (True=Yes/False=No)GCP_LiquidAtomization_freq This field reports the frequency of GCP Liquid AtomizationGCP_FuelDistributionCombZone This field reports the use of Good Combustion Practices Proper Fuel Distribution Combustion Zone. (True=Yes/False=No)GCP_FuelDistributionCombZone_freq This field reports the frequency of GCP Fuel Distribution Combustion ZoneGCP_CombustionAirDistribution This field reports the use of Good Combustion Practices Combustion Air Distribution (True=Yes/False=No)GCP_CombustionAirDistribution_freq This field reports the frequency with which GCP Combustion Air Distribution is used.GCP_FlyAshReinjection This field reports the use of Good Combustion Practices Fly Ash Reinjection. (True=Yes/False=No)GCP_DrierFuel This field reports on the Good Combustion Practices of using drier fuel. (True=Yes/False=No)GCP_FuelDistributioninFirebox This field reports on the Good Combustion Practice of proper Fuel Distribution. (True=Yes/False=No)GCP_Co-firing This field reports on the Good Combustion Practice of Co-Firing fuels (True=Yes/False=No)GCP_lowNOxBurners This field reports on the Good Combustion Practice using Low Nox Burners (True=Yes/False=No)Adjustments

This field reports the adjustment of CO, CO2, or other gas necessary to calculate combustion efficiency and make necessa

combustion system.

COLimit_UnitandCorrection This field reports the CO limit applicable to the unit or group of units.GasFuel This field reports the fuel combusted in the unit or group of units.

AverageTime This field reports the averaging time for the CO limit.AverageTimeOther This field reports if other information was entered about the CO limit averaging time.

SourceTab Indicates the Survey AnswerKey tab in which the data originated

Original UnitID This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.

Page 10 of 29
Appendix A-9: Field Mapping for the Data: Materials Combusted Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.UnitID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

StartupFuel This field lists any alternative fuel used at startup for the combustion unit.*Common StartupFuel This post-submittal field gives the standardized startup fuel type.

Startups This field indicates the number of unit startups per year.StartupLength This field gives the typical length of startup time in hours.Fuel This field lists the fuels or materials combusted by the unit.*Common Fuel This post-submittal field shows the standardized fuel name.DirectlyFedTo This field indicates where the fuel is fed. The answers include "B" for boiler, "P" for process heater, "G" for gasifier, or "O" FuelUsagePattern This field shows if the pattern of fuel usage is seasonal or annual.HoursPerYear This field gives the unit operation hours per year.

HeatMin This field gives the Minimum Heat Input in mmBtu/hr for the unit.HeatMax This field gives the Maximum Heat Input in mmBtu/hr for the unit.HeatMean This field gives the Mean Heat Input in mmBtu/hr for the unit.PermitLimitValue This field lists the permitted limit value.PermitLimitUnit This field gives the unit associated with the permit limit value.NRC_Fuel This field shows fuels that are occassionally, but not routinely combusted.*Common NRC_Fuel This post-submittal field gives the standardized NRC fuel type.

NRC_DirectlyFedTo This field indicates where fuel is fed. The answers include "B" for boiler, "P" for process heater, "G" for gasifier, or "O" for oNRC_Conditions This field indicates the conditions which lead to the combustion of fuels not routinely combusted.NRC_HoursPerYear This field provides the hours of fuels not routinely combusted burned per year.NRC_HeatMin This field gives the Minimum Heat Input of fuel not routinely combusted in mmBtu/hr.NRC_HeatMax This field gives the Maximum Heat Input of fuel not routinely combusted in mmBtu/hr.NRC_HeatMean This field gives the Mean Heat Input of fuel not routinely combusted in mmBtu/hr.NRC_PermitLimitValue This field lists the permitted limit value associated with the NRC.NRC_PermitLimitUnit This field gives the unit associated with the NRC permit limit value.

UnitIDChange (oldvalue) This post-submittal QA field shows the original Unit ID.Note This field provides space for additional information.* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 11 of 29
Appendix A-10: Field Mapping for the Data: Non-Fossil Fuels Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.UnitID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

NonFossilFuelUnits This field indicates the units that fire non-fossil fuels.NonFossilFuel This field gives the name of the non-fossil fuel burned.*Common Fuel This post-submittal field shows the standardized fuel name.HandlingMethod This field describes the alternative disposal method for non-fossil fuel if not combusted.CompensatoryFuel This field describes the fuel used to compensate if the facility is not able to burn non-fossil fuel.

CompensateForLostHeat This field describes the alternative to compensate for lost heat if non-fossil fuel isn't combusted.StopCombustingNFF This field shows if the facility would be forced to stop burning non-fossil fuel if subject to Sectioln 129 CISWI. (True=Yes/FaCoststoComplywith129 This field lists the additional costs to comply with 129.CostComponents This field provides space to list the additional cost components necessary to comply with 129.Original UnitID This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.* This field has been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 12 of 29
Appendix A-11: Field Mapping for the Data: Regulatory and Permit Limits Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

Pollutant This field identifies the Permitted Pollutant described in the record.

EL This field gives the Numerical Emission Limit.EL_Units This field gives the Emission Limit Units as lb/mmBtu or Other.EL_Units_Other This field provides space to give Other Limit Units, where applicable.

EL_FuelAssoc This field indicates the fuel associated with the Emission Limit.

AveragingTime This field gives the averaging time for the limit, such as hourly, 30-day average, etc.

O2orCO2Concentration This field contains the standardized oxygen concentration.

EL_ReflectDDDDD This field indicates emission limits that reflect DDDDD. (True=Yes/False=No)Note This field provides space for additional Information

Page 13 of 29
Appendix A-12: Field Mapping for the Data: Stack Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.UnitID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

SingleStack This field indicates if the stack is used by a single combustion unit. (True=Yes/False=No)

CommonStack This field indicates if the stack is used by multiple combustion units. (True=Yes/False=No)OtherCombustionUnits This field provides a list of other combustions units using a stack, if it is a common stack. Should correspond to a "Yes" in MultipleStacks This field indicates the use of multiple stacks by a single combustion unit. (True=Yes/False=No).

Page 14 of 29
Appendix A-13: Field Mapping for the Data: Unit Design/Operation Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.UnitID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

*Classification This post-submittal QA field identifies the combustion device as a boiler, process heater, incinerator, generator, kiln or othe

YearInstalled This field gives the year the combustion device was installed.Capacity This field lists the Heat Input value for the combustion unit.

CapacityUnit This field gives the Heat Input value units.*Standardized Capacity This post-submittal field contains the Heat Input value converted to standardized units.*Standardized CapacityUnit This post-submittal field lists the Heat Input unit for the Standardized Capacity field.

Fuel This field gives the type of fuel used in the combustion device.HeatReleaseRate This field lists the Heat Release Rate in units of Btu per cubic foot.NSPS This field indicates if the unit is subject to New Source Performance Standards. (True=Yes/False=No).NSPSYear

This field gives the year in which the combustion unit is subject to New Source Performance Standards. Should correspon

NSPS field.

PCD_SteamGen This field indicates that the unit's primary use is steam generation. (True=Yes/False=No)

PCD_SpaceHeat This field indicates that the unit's primary use is space heat generation. (True=Yes/False=No)PCD_ProcessHeat This field indicates that the unit's primary use is process heat generation. (True=Yes/False=No)PCD_ElectricityGen This field indicates that the unit's primary use is electricity generation. (True=Yes/False=No)PCD_WasteIncineration This field indicates that the unit's primary use is waste incineration. (True=Yes/False=No)PCD_Cogen This field indicates that the unit's primary use is co-generation. (True=Yes/False=No)PCD_Other This field indicates that the unit has another primary use besides those listed. (True=Yes/False=No)PCD_OtherExp This field provides space to explain the unit's secondary use. Should correspond to a "Yes" response in the "PCD_Other" ACD_SteamGen This field indicates that the unit's secondary use is steam generation. (True=Yes/False=No)ACD_SpaceHeat This field indicates that the unit's secondary use is space heat generation. (True=Yes/False=No)ACD_ProcessHeat This field indicates that the unit's secondary use is process heat generation. (True=Yes/False=No)ACD_ElectricityGen This field indicates that the unit's secondary use is electricity generation. (True=Yes/False=No)ACD_WasteIncineration This field indicates that the unit's secondary use is waste incineration. (True=Yes/False=No)ACD_Cogen This field indicates that the unit's secondary use is co-generation. (True=Yes/False=No)ACD_Other This field indicates that the unit has another secondary use besides those listed. (True=Yes/False=No)ACD_OtherExp This field provides space to explain the unit's primary use. Should correspond to a "Yes" response in the "ACD_Other" fielBlr_Package This field indicates that the combustion device is a shop erected package boiler.Blr_FieldErected This field indicates that the combustion device is field erected.Blr_Modular This field indicates that the combustion device was erected partly in a shop and partly in the field.Blr_WaterTube This field indicates that the combustion device is a water tube boiler.Blr_FireTube This field indicates that the combustion device is a fire tube boiler.Blr_Hybrid This field indicates that the combustion device is a hybrid boiler.Blr_HybridWater This field indicates that the combustion device is a hybrid water tube boiler.Blr_HybridFire This field indicates that the combustion device is a hybrid fire tube boiler.Blr_Tangential This field indicates that the combustion device is a boiler with tangential suspension firing.Blr_WallFired This field indicates that the combustion device is a boiler with wall-fired suspension firing.

Page 15 of 29
Appendix A-13: Field Mapping for the Data: Unit Design/Operation Table

Field Name DescriptionBlr_Combo This field indicates that the combustion device is a boiler with a combination of suspension firing and grate-firing.Blr_OtherSuspension This field indicates that the combustion device is a boiler with another form of suspension firing.Blr_OtherSuspensionExp This field explains the suspension firing method utilized by the boiler.BlrStoker This field indicates that the combustion device is a stoker solid-fuel boiler.

BlrStoker_Spreader This field indicates that the combustion device is a spreader-stoker solid-fuel boiler.BlrStoker_MassFeed This field indicates that the combustion device is a mass feed solid-fuel boiler.BlrStoker_ManualFeed This field indicates that the combustion device is a manual-feed solid-fuel boiler.BlrStoker_Other This field indicates that the combustion device is a stoker boiler of another type.BlrStoker_OtherExp This field provides space to explain the type of stoker solid-fuel boiler. Should correspond to a "Yes" response in the "BlrS

Blr_FluidBed This field indicates that the combustion device is a fluidized-bed solid-fuel boiler.

Blr_FluidBed_Circulating This field indicates that the combustion device is a circulating fluidized-bed solid-fuel boiler.Blr_FluidBed_Bubbling This field indicates that the combustion device is a bubbling fluidized-bed solid-fuel boiler.Blr_PulverizedCoal This field indicates that the combustion device is a pulverized coal solid-fuel boiler.Blr_Cyclone This field indicates that the combustion device is a cyclone boiler.BlrOtherUnit_FuelCell This field indicates that the combustion device is a fuel-cell solid-fuel boiler.BlrOtherUnit_SuspBurner This field indicates that the combustion device is a suspension burner solid-fuel boiler.

BlrOtherUnit_SlopedGrate This field indicates that the combustion device is a sloped grate solid-fuel boiler.BlrOtherUnit_DutchOven This field indicates that the combustion device is a dutch oven solid-fuel boiler.BlrOtherUnit_Gasifier This field indicates that the combustion device is a gasifier solid-fuel boiler.BlrOtherUnit_Other This field indicates that the combustion device is another type of solid-fuel boiler.

BlrOtherUnit_OtherExp This field provides space to explain the type of solid-fuel boiler. Should correspond to a "Yes" response in the "BlrOtherUnPH_Package This field indicates if the unit is a shop-erected process heater package unit. (True=Yes/False=No).PH_FieldErected This field indicates if the unit is a field-erected process heater. (True=Yes/False=No).PH_FireTube This field indicates if the unit is a fire-tube process heater. (True=Yes/False=No).PH_WaterTube This field indicates if the unit is a water-tube process heater. (True=Yes/False=No).PH_ThermalOil This field indicates if the unit is a thermal oil process heater. (True=Yes/False=No).PH_OtherUnit This field indicates that the unit is another type of process heater. (True=Yes/False=No)PH_OtherUnitExp This field provides space to explain the type of process heater. Should correspond to a "Yes" response in the "PH_OtherUPH_FuelCell This field indicates if the unit is a fuel cell process heater. (True=Yes/False=No).PH_SuspBurner This field indicates if the unit is a suspension burner process heater. (True=Yes/False=No).

PH_SlopedGrate This field indicates if the unit is a slope grateprocess heater. (True=Yes/False=No).PH_DutchOven This field indicates if the unit is a dutch oven process heater (True=Yes/False=No).PH_Gasifier This field indicates if the unit is a gasifier process heater. (True=Yes/False=No).PH_OtherFiring This field indicates if the unit is an unlisted type of process heater. (True=Yes/False=No).

PH_OtherFiringExp This field provides space to explain how the process heater is fired. Should correspond to a "Yes" response in the "PH_OtOC_NaturalDraft This field indicates if the combustion unit utilizes natural draft. (True=Yes/False=No).OC_ForcedDraft This field indicates if the combustion unit utilizes forced draft. (True=Yes/False=No).OC_Dryer This field indicates if the combustion unit is a dryer. (True=Yes/False=No).

OC_Heater This field indicates if the combustion unit is a heater. (True=Yes/False=No).

Page 16 of 29
Appendix A-13: Field Mapping for the Data: Unit Design/Operation Table

Field Name DescriptionOC_Kiln This field indicates if the combustion unit is a kiln. (True=Yes/False=No).OC_Engine This field indicates if the combustion unit is an engine. (True=Yes/False=No).OC_Other This field indicates if the combustion unit is another type of unit. (True=Yes/False=No).OC_OtherExp This field provides space to explain the type of combustion unit. Should correspond to a "Yes" response in the "OC_OtherOperationHours This field gives operation hours for the combustion unit, in hr/yrDutyCycle This field indicates if the unit duty cycle is base-loaded, load following or standby.Seasonal This field indicates if the combustion unit operates seasonally.Unit ID Changed This post-submittal QA field indicates that the Unit ID was corrected.Original Unit ID This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.* This field has been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 17 of 29
Appendix B-1: Field Mapping for the Data: 30day Control Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID_common This contains a unique identifier assigned to each combustion unit.Date This field identifies the Date (mm,dd,yy) for CEMS daily average emission data point for most recent 30-day periodControlDevice This identifier lists any add-on Pollution Control Device.ControlDevice_OtherExp This field identifies if other control device information was entered.InletTemp This field identifies the inlet templerature to the control device.InletTemp_Unit This field identifies the inlet temperature units of measure.

OutletTemp This field identifies the outlet templerature from the control device.OutletTemp_Unit This field identifies the outlet temperature units of measure.InjectionLocation This field identifies the location of sorbent injection for treatment of exhaust gas.InletVoltage This field identifies the inlet voltage to an electrostatic precipitator.

OutletVoltage This field identifies the outlet voltage from an electrostatic precipitator.InletSecCurrent This field identifies the inlet secondary current to an electrostatic precipitator.OutletSecCurrent This field identifies the outlet secondary current from an electrostatic precipitator.ControlDevice_Note This field provides space for additional information.PressureDrop This field identifies the pressure drop across a control device.SorbentInjRate This field identifies the rate at which sorbent is injected.SorbentInjRate_Unit This field identifies the units for the rate of sorbent injection.

SorbentInjRate_Unit_Other This field identifies if other sorbent injection rate unit information was entered.ScrubberLiquor_pH This field identifies the pH of the wet scrubber liquor.ScrubberLiquor_Rate This field identifies the wet scrubber liquor flow rate.

AmmoniaSlip This field identifies the ammonia slip for SCR and SNCR, in ppm.

ReagentType This field identifies the reagent for SCR or SNCR, urea or ammonia.OtherMonitorParameter_Type This field identifies other control device parameters not identified in the templates.OtherMonitorParameter_Value This field identifies numeric values accompanying the other monitoring parameter types.OtherMonitorParameter_Unit This field identifies units of measure for the numeric values acocmpanying the other monitoring parameter types.SourceTab This field indicates the 30DayProcessInformationTemplate tab in which the data originated

Page 18 of 29
Appendix B-2: Field Mapping for the Data: 30day Fuel Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID_common This contains a unique identifier assigned to each combustion unit.Date This field identifies the Date (mm,dd,yy) for CEMS daily average emission data point for most recent 30-day periodFuel_Number This field lists the number of the fuel entered into the 30DayProcessInformationTemplate.Fuel This field lists the fuel or material for which analysis is included.Fuel_Other This field identifies if other fuel information was entered.

Fuel_Rate This field identifies the fuel input rate.Fuel_Rate_Unit This field identifies the unit of measure accompanying the fuel input rate.

Fuel_Rate_Unit_Other This field identifies if other fuel input rate unit of measure information was entered.SourceTab This field indicates the 30DayProcessInformationTemplate tab in which the data originated

Page 19 of 29
Appendix B-3: Field Mapping for the Data: 30day Process Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID_common This contains a unique identifier assigned to each combustion unit.Date This field identifies the Date (mm,dd,yy) for CEMS daily average emission data point for most recent 30-day periodTHI This value gives the total heat input.Steam This value gives the steam output.Exhaust_Flow This field gives the exhaust flow rate.Exhaust_Flow_Unit This field gives the original exhaust flowrate units.

Exhaust_Temp This field gives the exhaust temperature.Exhaust_Temp_Unit This field provides the original unit for Exhaust Temperature

O2_% This field gives the O2 concentration in the exhaust.Moisture_% This field gives the moisture concentration in the exhaust.Note This field provides space for additional information.SourceTab This field indicates the 30DayProcessInformationTemplate tab in which the data originated

Page 20 of 29
Appendix B-4: Field Mapping for the Data: CEMS Table

Field Name Description*Major Source? This post-submittal field shows whether the facility is an area source or major source.*Classification This post-submittal field shows the classification of the unit.*Data Source This post-submittal field shows the data-gathering phase from which the data was received.FacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combu

the IDNote field

Source This field identifies the source of the data as CEMS or SmallGasCEMS.

Pollutant This field identifies the pollutant being monitored as CO, NOx, SO2, Opacity, or PM.Date This field identifies the Date (mm,dd,yy) for CEMS daily average emission data point for most recent 30-day periodEmission_Numerical This field contains the emission numerical value for CEMS daily average emission data point for most recent 30-day periodEmission_Unit This field has the units for CEMS daily average emission data point for most recent 30-day periodCorrection This field has the pertinent dilutant gas needed to correct the emissions. i.e. 3% Oxygen.*Standardized Emission_Numerical This post-submittal field gives the submitted emission data in terms of standardized units.*Standardized Emission _Unit This post-submittal field gives the standardized units which correspond to the standardized numerical emission, either lb/MConversion EqUsed This post-submittal field identifies the equation used to convert the received emission data to standard units.*F-Factor Standardized Value This post-submittal field provides the F-Factor needed to convert data into standard units.

*F-Factor Standardized Unit This post-submittal field gives the standardized units which correspond to the standardized numerical emission, either lb/M

F-Factor Equation Used This post-submittal field identifies the F-Factor equation used to convert the received emission data to standard units.MaxEmission_Numerical This field contains the maximum emission numerical value for CEMS daily average emission data point for most recent 30

MaxEmission_Unit This field contains the maximum emission units for CEMS daily average emission data point for most recent 30-day periodMaxCorrection This field has the pertinent dilutant gas needed to correct the emissions. i.e. 3% Oxygen*Standardized MaxEmission_Numerical This post-submittal field gives the submitted maximum emission data in terms of standardized units.*Standardized MaxEmission_Unit This post-submittal field gives the standardized units which correspond to the standardized max numerical emission, either *Max Conversion Equation Used This post-submittal field identifies the equation used to convert the received max emission data to standard units.*F-Factor MaxEmission_Numerical This post-submittal field provides the F-Factor needed to convert max emission data into standard units.*F-Factor MaxEmission_Unit This post-submittal field gives the standardized units which correspond to the standardized max numerical emission, either *F-Factor MaxEmission Eq Used This post-submittal field identifies the F-Factor equation used to convert the received max emission data to standard units.Note This field provides space for additional information.*Cleaned Control Device This post-submittal field identifies all control devices employed during the monitoring period.*Total Baseline Control This post-submittal field identifies the total baseline level of control during the monitoring period.*Fuel This post-submittal field identifies all fuels combusted during the monitoring period.*Fuel Source This post-submittal field identifies the source of the fuel information.*Coal % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting coal.*Bagasse % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting bagasse.*Wet Biomass % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting wet biomass

Page 21 of 29
Appendix B-4: Field Mapping for the Data: CEMS Table

Field Name Description*Dry Biomass % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting dry biomass*Heavy Liquid % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting heavy liquid*Light Liquid % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting light liquid.*Gas 1% This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting gas 1.*Gas 2% This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting gas 2.*Other % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting other.*Waste % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting waste.*25% Fuel Cat This post-submittal field contains the fuel category assigned to the data point based on the fuel percentage fields, using a 2*10% Fuel Cat This post-submittal field contains the fuel category assigned to the data point based on the fuel percentage fields, using a Heat_Input This field identifies the total heat input to the combustion unit for each monitoring period (mmBtu/hr)Steam This field identifies the total steam output from the combustion unit for each monitoring period (1000 lb/hr)CombUnit_Op_Indicator This field identifies if the combustion unit was in a period of startup, shutdown, malfunction, or normal operation.CEMS_Op_Indicator This field identifies if the monitor experienced a malfunction.

SourceTab This field indicates the CEMSSpreadsheet tab in which the data originated

*Test Burning Proposed Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the *Test Burning Alternative Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the *Alternative Waste Inventory? This post-submittal field notes if thes combustion unit would be reclassified as a waste-burning unit under the alternative so* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 22 of 29
Appendix B-5: Field Mapping for the Data: CO and THC CEMS Table

Field Name Description*Major Source? This post-submittal field shows whether the facility is an area source or major source.*Classification This post-submittal field shows the classification of the unit.*Data Source This post-submittal field shows the data-gathering phase from which the data was received.SourceTab This field indicates the COandHCMonitoringTemplate tab in which the data originatedFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID This contains a unique identifier assigned to each combustion unit.Date This field identifies the Date (mm,dd,yy,hh) for CEMS daily average emission data point for most recent 30-day periodTHC This field contains the monitored emission value for total hydrocarbons (ppm)*THC (ppm@3%O2) This post-submittal field contains the standardized total hydrocarbon emissions (ppm @ 3% O2)*THC Equation Used This post-submittal shows the equation ID used to standardized the reported emission dataCH4 This field contains the monitored emission value for methane (ppm)*CH4 (ppm@3%O2) This post-submittal field contains the standardized methane emissions (ppm @ 3% O2)*CH4 Equation Used This post-submittal shows the equation ID used to standardized the reported emission dataNon_CH4_HC This field contains the monitored emission value for non-methane hydrocarbons (ppm)*Non_CH4_HC (ppm@3%O2) This post-submittal field contains the standardized non-methane hydrocarbon emissions (ppm @ 3% O2)*Non_CH4_HC Equation Used This post-submittal shows the equation ID used to standardized the reported emission dataCO This field contains the monitored emission value for carbon monoxide (ppm)*CO (ppm@3%O2) This post-submittal field contains the standardized carbon monoxide emissions (ppm @ 3% O2)*CO Equation Used This post-submittal shows the equation ID used to standardized the reported emission dataO2_in_Stack This field indicates the percent oxygen in the exhaust during the monitoring period.Heat_Input This field indicates the heat input to the combustion unit during the monitoring period (mmBtu/hr)Steam This field indicates the steam output from the combustion unit during the monitoring period (1000 lb/hr)CombUnit_Op_Indicator This field identifies if the combustion unit was in a period of startup, shutdown, malfunction, or normal operation.THC_Op_Indicator This field identifies if the monitor experienced a malfunction.CO_Op_Indicator This field identifies if the monitor experienced a malfunction.*Alternative Waste Inventory? This post-submittal field notes if thes combustion unit would be reclassified as a waste-burning unit under the alternative so*Test Burning Alternative Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the *Test Burning Proposed Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the * These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 23 of 29
Appendix B-6: Field Mapping for the Data: CO and THC CEMS Backgrnd Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID This contains a unique identifier assigned to each combustion unit.TypFuel This field lists the fuel or material combusted during the CEM analysis.TypFuel_Other This field identifies if other fuel information was entered.

TypFuelRate This field identifies the fuel input rate.TypFuelRateUnits This field identifies the unit of measure accompanying the fuel input rate.

TypFuelRateUnits_Other This field identifies if other fuel input rate unit of measure information was entered.SourceTab This field indicates the COandHCMonitoringTemplate tab in which the data originated

Page 24 of 29
Appendix B-7: Field Mapping for the Data: EmissionsTest Table

Field Name Description*Major Source? This post-submittal field shows whether the facility is an area source or major source.*Classification This post-submittal field shows the classification of the unit.*Data Source This post-submittal field shows the data-gathering phase from which the data was received.SourceTab This field indicates the EmissionTestSprdsheet tab in which the data originatedFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID_common

This contains a unique identifier assigned to each combustion unit. For units with an identifier representing multiple combustion 

in the IDNote field

TestID This field contains an identifying sample number for tracking emission test results.TestDate_common This field contains the date of emission testPollutant_Name This field shows the name of the pollutant being testedPollutant_Value This field shows the pollutant value submitted originally, which is non-numeric.*Pollutant_Value Numeric This field is a numeric post-submittal QA field created to allow calculations using the pollutant value.Non-Detect? This post-submittal field identifies non-detect results.*ND Detection Limit This field gives the detection limit for the pollutant represented in the record.Pollutant_Units This field shows the units for pollutant value. Pollutant_UnitsOther This filed offers pollutant alternative unit information. Should correspond to an "Other" response n the Parameter_Units.*Standardized Detection Limit This post-submittal field reports the non-detect detection limit in standardized units.*Standardized Detection Limit Units This post-submittal field gives the units in which the standardized detection limit is reported.Pollutant_Average This field gives the average pollutant value.*Standardized Pollutant_Value This post-submittal QA field contains a standardized pollutant value.*Standardized Pollutant_Units This field includes a post-submittal QA field showing pollutant standardized unit.*Conversion Eq Used This field shows a post-submittal QA field identifying the equation used to convert pollutant value to standard unit*F-Factor Standardized Value This post-submittal field provides the F-Factor needed to convert the pollutant into standard units.*F-Factor Standardized Unit This post-submittal field gives the standardized units which correspond to the standardized numerical emission, either lb/MMBtu *F-Factor Equation Used This post-submittal field identifies theF-Factor equation used to convert the received emission data to standard units.Pollutant_Method This field identifies the Pollutant Test Method used.Pollutant_Location This field indicates if the sample taken before or after control device*Upstream/Downstream? This post-submittal field standardizes the sampling location (upstream, downstream, or unknown).Pollutant_Note This field provides space for additional supportive information regarding the pollutantOriginal CombustorID_common This is a post-submittal QA field showing the original Unit ID.Note This field provides space for additional information.*Cleaned Control Device This post-submittal field identifies all control devices employed during the emission test.*Total Baseline Control This post-submittal field identifies the total baseline level of control during the emission test.*Control Source This post-submittal field identifies the source of the control device information.*Fuel This post-submittal field identifies all fuels combusted during the emission test.*Fuel Source This post-submittal field identifies the source of the fuel information.*Coal % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting coal.*Bagasse % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting bagasse.

*Wet Biomass % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting wet biomass.*Dry Biomass % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting dry biomass.*Heavy Liquid % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting heavy liquid.

Page 25 of 29
Appendix B-7: Field Mapping for the Data: EmissionsTest Table

Field Name Description*Light Liquid % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting light liquid.*Gas 1% This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting gas 1.*Gas 2% This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting gas 2.*Other % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting other.*Waste % This post-submittal field contains the percentage of the combustion unit's heat input that is due to combusting waste.*25% Fuel Cat This post-submittal field contains the fuel category assigned to the data point based on the fuel percentage fields, using a 25% t*10% Fuel Cat This post-submittal field contains the fuel category assigned to the data point based on the fuel percentage fields, using a 10% tTotal_Solids This field indicates the total solids recirculated from wet scrubber liquid.Total_Solids_Unit This field shows the units of measure for the total solids recirculation.Total_Solids_Method This field shows the method used to measure the total solids recirculation.Total_Solids_Location This field shows the location where total solids recirculation was measured.Total_Solids_Note This field provides space for additional supportive information regarding total solids recirculation.Dissolved_Solids This field indicates the total dissolved solids recirculated from wet scrubber liquid.Dissolved_Solids_Unit This field shows the units of measure for the total dissolved solids recirculation.Dissolved_Solids_Method This field shows the method used to measure the total dissolved solids recirculation.Dissolved_Solids_Location This field shows the location where total dissolved solids recirculation was measured.Dissolved_Solids_Note This field provides space for additional supportive information regarding total dissolved solids recirculation.Suspended_Solids This field indicates the total suspended solids recirculated from wet scrubber liquid.Suspended_Solids_Unit This field shows the units of measure for the total suspended solids recirculation.Suspended_Solids_Method This field shows the method used to measure the total suspended solids recirculation.Suspended_Solids_Location This field shows the location where total suspended solids recirculation was measured.Suspended_Solids_Note This field provides space for additional supportive information regarding total suspended solids recirculation.Recirc_Flowrate This field indicates the recirculation flowrate of the wet scrubber liquid.Recirc_Flowrate_Unit This field shows the units of measure for the recirculation flowrate.

Recirc_Flowrate_Method This field shows the method used to measure the recirculation flowrate.Recirc_Flowrate_Location This field shows the location where recirculation flowrate was measured.Recirc_Flowrate_Note This field provides space for additional supportive information regarding recirculation flowrate.Sample Half This denotes specific information on front or back half measurements as reported in the ERT.*Combustor Design This post-submittal field notes the combustor design of the combustion unit.*Multiple Combustors? This post-submittal field notes where the CombustorID is indicative of multiple combustion units.*Alternative Waste Inventory? This post-submittal field notes if thes combustion unit would be reclassified as a waste-burning unit under the alternative solid w*Test Burning Alternative Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the altern*Test Burning Proposed Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the propo* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 26 of 29
Appendix B-8: Field Mapping for the Data: FuelAnalysis Table

Field Name DescriptionFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.Fuel_Material This field lists the fuel or material for which analysis is included.Fuel_Material_Other This field identifies if other fuel information was entered.

*Common Fuel This post-submittal field shows the standardized fuel name.FM_analysiswithEmissionTest This field indicates if the fuel or material analysis was completed in conjunction with an emission test. (True=Yes/False=No

CombustorID_common

This contains a unique identifier assigned to each combustion unit and matches the ID in the EmissionsTest table . For uni

multiple combustion units a note is provided in the IDNote field

SampleID This identifier gives the sample number associated with the analysis.TestDate_common This field gives the date the analysis was performed.FuelSampleDate This field gives the date the fuel sample was taken.Basis This field indicates if fuel basis is As received or Dry

Parameter_Name This field names the parameter of either Higher Heating Value (HHV) or Compound.Parameter_Value This field contains the value of either HHV or Compound as text.Parameter_Units This field gives the units of either HHV or Compound.Parameter_UnitsOther The field provides space to list units of HHV or Compound if "other" is indicated as units.Parameter_TestMethod This field lists the method used to analyze HHV or Compound.*CorrectedParameter_Units This field gives the standard units for HHV or Compound. (Btu/lb, Btu/gal or Btu/scf)*ParameterValueNumeric This post-submittal field provides a numeric version of the reported parameter value.*ParameterValueisNonDetect This post-submittal field identifies non-detect results.

*StdParameterConc(mgperg dry) This post-submittal field converts the reported pollutant concentrations to a standardized concentration (mg/g).

*StdParameterNote This field provides space for additional information.*StandardizedHHV(mmBtuperlb drybasis) This post-submittal field provides a standardized heating value for the specific test run (mmBtu/lb).*HHVNote This field provides space for additional information.*StdFuelBased EF (lbpermmBtu) This post-submittal field standardizes the concentrations into a heat input-based emission factor (lb/mmBtu).*StdParameter for EF This post-submittal field standardizes the parameter name.*StdFuelBased EF note This field provides space for additional information.SourceTab This field indicates the FuelAnalysisSpreadsheet tab in which the data originated

*Data Source This post-submittal field shows the data-gathering phase from which the data was received.*Proposed Option Waste? This post-submittal field notes if the fuel analysis data corresponds to a fuel classified as a solid waste under the proposed *Alternative Option Waste? This post-submittal field notes if the fuel analysis data corresponds to a fuel classified as a solid waste under the alternativ* These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 27 of 29
Appendix B-9: Field Mapping for the Data: Total Metals Emissions Table

Field Name Description*Data Source This post-submittal field shows the data-gathering phase from which the data was received.Source Tab This field indicates the EmissionTestSprdsheet tab in which the data originatedFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID_common This contains a unique identifier assigned to each combustion unit.TestID This field contains an identifying sample number for tracking emission test results.TestDate_common This field contains the date of emission test*Total Metals This post-submittal field presents the calculated total metals emission value for the test run.*Total Metals Unit This post-submittal field presents the unit of measure for the total metals emission value.

*Has ND Data? This post-submittal field indicates if non-detect data was included in the total metals value.Note This field provides space for additional information.Test Method This field identifies the Pollutant Test Method used.

*Alternative Waste Inventory? This post-submittal field notes if thes combustion unit would be reclassified as a waste-burning unit under the alternative so*Test Burning Alternative Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the *Test Burning Proposed Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the * These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 28 of 29
Appendix B-10: Field Mapping for the Data: Total PCDD/PCDF Emissions (TEQ & Total Mass) Table

Field Name Description*Data Source This post-submittal field shows the data-gathering phase from which the data was received.Source Tab This field indicates the EmissionTestSprdsheet tab in which the data originatedFacilityID This identifier relates each record to a unique facility using a two-letter state abbreviation and abbreviated facility name.CombustorID_common This contains a unique identifier assigned to each combustion unit.TestID This field contains an identifying sample number for tracking emission test results.TestDate_common This field contains the date of emission test*Reported Value This post-submittal field contains the reported total mass dioxin/furan emission value for the test run, if applicable.*Calculated Value This post-submittal field contains the calculated total mass dioxin/furan emission value for the test run, if applicable.*Total Mass PCDD/PCDF This post-submittal field contains the total mass dioxin/furan emission value for the test run.*Total Mass PCDD/PCDF Unit This post-submittal field contains the units of measure for the total mass dioxin/furan emission value.

*Total Mass PCDD/PCDF Source This post-submittal field states whether the total mass dioxin/furan value is the reported or calculated value.

*Has Total Mass ND Data? This post-submittal field states if the total mass dioxin/furan value contains non-detect data.*TEQ PCDD/PCDF This post-submittal field contains the TEQ dioxin/furan emission value for the test run.*TEQ PCDD/PCDF Unit This post-submittal field contains the units of measure for TEQ mass dioxin/furan emission value.

*Has TEQ ND Data? This post-submittal field states if the TEQ dioxin/furan value contains non-detect data.Note This field provides space for additional information.*Alternative Waste Inventory? This post-submittal field notes if thes combustion unit would be reclassified as a waste-burning unit under the alternative so

*Test Burning Alternative Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the *Test Burning Proposed Option Waste? This post-submittal field notes if the emissions data corresponds to combusting a fuel classified as a solid waste under the * These fields have been added to the database to allow the survey data to be standardized to ensure uniformity in emission and cost calculations.

Page 29 of 29
APPENDIX C 

2008 QUESTIONNAIRE EXCEL TEMPLATES
Survey Question: Part I 

(Questions on this worksheet start on page 3 of the survey overview document)

Worksheet Title: Facility Level Data

Who Should Complete this Spreadsheet?

Spreadsheet Instructions:

1. Name of facility: facility name here2. Complete street address of facility (physical location):

a. Addressb. Cityc. Stated. Zipe. County 

3. Facility contact:

a. Name (First Name, Last Name)b. Titlec. Telephone number and ext.d. Fax Numbere. E-mail Address

4. If not the same as question #1, provide the legal name of the owner of this facility:5. Is the owner of this facility a private enterprise,not-for-profit, or a public sector entity? (select one)

Any facility that receives the Section 114 letter that still has boilers*, process heaters*, other combustion units*, or incinerators* in operation.

ICR Number 2286.01

OMB Control Number: 

2060-0616

Expiration Date: 08/31/2011

EPA Form No. 5900-122

Please answer these questions for the facility listed in the Section 114 letter you received in the mail. If you received more than one Section 114 letter for multiple facilities, you must create a separate answer key spreadsheet file for each facility. 

Private EnterpriseNot-for-ProfitPublic Sector

Owner Type

(select)
6. Is your facility a major source* of HAP?7. Size of EntityNotes:Peach shaded cells indicate areas where the user will enter a response* Indicates a definition of the term is available in the Survey Overview Document

Now Proceed to Worksheet II.A.1 (boiler group) in the Survey

9. Select the facility’s primary NAICS.The primary NAICS code represents the line of business that generates the most income for the facility.7a1. If a private company owns the facility, please enter the approximate number of employees of the business enterprise that owns this facility, including where applicable, the parent company

and all subsidiaries, branches, and unrelated establishments owned by the parent company:7a2. If a private company owns the facility, please enter the number of employees at this facility:7b1. If the public sector owns the facility, what is the population of the local government entity(city, county, town, school district, special district) that owns the facility?

8. Is the legal owner a small entity* as defined by the Regulatory Flexibility Act?Go to this website for help determining small entity status:http://www.sba.gov/idc/groups/public/documents/sba_homepage/serv_sstd_tablepdf.pdf

YesNo

Major Source

(select)(select)(select)

YesNoDon't Know

Small Entity

(select)
Survey 

Question: Part II.A Question 1 (Questions on this worksheet start on page 4 of the survey overview document) ICR Numbe

Worksheet Title: Design, Operating, and Air Pollution Control Device Data for Small Gas-fired* Boilers OMB Contro

EPA Form N

Who Should 

Complete this Spreadsheet? Facilities that have small gas-fired* boilers

Expiration D

Facility Name (name of facility will automatically be linked to the name you provided in Part I): Group ID associated with this similar group of small gas-fired* boilers:

1. Please provide a brief inventory of each similar group of small gas fired boilers:

a. Enter the number of gas fired boilers in this group with less than or equal to 10 million Btu/hr (mmBtu/hr) heat input design capacity:

frequency:frequency:frequency:frequency:

If this option is checked, indicate what level the CO is adjusted to:

Inspection and repair of all valves (relief, safety, hydraulic, pneumatic, etc.). frequency:

b. Please classify any tune-up practices performed on this group of boilers along with the corresponding frequency. Tune-up practices incthe unit’s combustion processes and adjusting as needed:

Using the scheduled tune-up and procedures provided by the boiler manufacturer.Inspection and cleaning, as necessary, of fireside and water-side surfaces.Inspecting, cleaning and/or reconditioning of fuel systems.

facility name here

Checking all electrical and combustion control systems.Testing of exhaust gases (CO, CO2, other) as necessary to calculate combustion efficiency and make 

necessary adjustments to the combustion system.

frequency: 

Spreadsheet Instructions:Complete this worksheet for each similar group of small gas-fired boilers. If you have more than one similar group of gas-fired boilers, you may copy and paste unique group of units. To copy and paste a worksheet, follow these steps: 1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 2. In the pop-up window, check the box next to "Create a copy" 3. Under "Before Sheet", select the name of the current sheet you are working in 4. Click OK. 5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet. The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied workshee-mail this spreadsheet along with all other completed spreadsheets tcombustionsurvey@erg comSpreadsheet Instructions:Complete this worksheet for each similar group of small gas-fired boilers. If you have more than one similar group of gas-fired boilers, you may copy and paste unique group of units. To copy and paste a worksheet, follow these steps: 1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 2. In the pop-up window, check the box next to "Create a copy" 3. Under "Before Sheet", select the name of the current sheet you are working in 4. Click OK. 5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet. The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied workshee-mail this spreadsheet along with all other completed spreadsheets tcombustionsurvey@erg com
frequency:frequency:frequency:frequency:frequency:frequency:frequency:frequency:frequency:frequency:frequency:

d. If any of these boilers is subject to a CO limit, please provide the numerical limit with units.

CO numerical limit with units and correction:

(e.g. 400 ppm at 3% O2 dry, lb/mmBtu heat input, or other (please specify)

Fuel associated with numerical limit (select from list):

Corresponding Averaging Time for CO limit:

if CO averaging time is 'other', please specify:

Now Proceed to Worksheet Part II.A.2 (heater group)

Inspection and repair of refractories.Cleaning/reconditioning and inspecting the feedwater system.Using up to date operating procedures, training, recordkeepingMonitoring furnace residence time and temperatureFuel quality and proper fuel handling (including monitoring quality, periodic sampling and analysis, fuel supplier certification, if used)Proper fuel distribution in the combustion zoneMaintenance knowledge (including training on applicable equipment and procedures)Maintenance practices including maintenance procedures and recordkeeping

c. Please classify any good combustion practices performed on this group of boilers, along with the corresponding frequency of each prac

Cleaning and inspecting fan housing, blades, and inlet screens.Fuel/air ratio periodic checksAutomatic O2/CO trim control systems (check if controls are installed)

Low NOx burners (check if burners are installed)Combustion air distribution based on observations with periodic or continuous adjustments

(select)

30-day rolling average 

Averaging Time 
ICR Number 2286.01

OMB Control Number: 2060-0616

Expiration Date: 08/31/2011

Survey 

Question: Part II.A Question 2 (Questions on this worksheet start on page 4 of the survey overview document) ICR Number 2286.01

Worksheet Title: Design, Operating, and Air Pollution Control Device Data for Small Gas-fired* Process Heaters OMB Control Number: 2060-0616

EPA Form No. 5900-122

Who Should 

Complete this 

Spreadsheet? Facilities that have small gas-fired* process heaters

Expiration Date: 08/31/2011

Facility Name (name of facility will automatically be linked to the name you provided in Part I): facility name here

Group ID associated with this similar group of small gas-fired* process heaters:

1. Please provide a brief inventory of each similar group of small gas fired process heaters:

a. Enter the number of gas fired process heaters in this group with less than or equal to 10 million Btu/hr 

(mmBtu/hr) heat input design capacity:

frequency:

frequency:

frequency:

frequency:

If this option is checked, indicate what level the CO is adjusted to:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

d. If any of these process heaters is subject to a CO limit, please provide the numerical limit with units.

CO numerical limit with units and correction:

(e.g. 400 ppm at 3% O2 dry, lb/mmBtu heat input, or other (please specify)

Fuel associated with numerical limit (select from list):

Corresponding Averaging Time for CO limit:

if CO averaging time is 'other', please specify:

Now Proceed to Worksheet Part II.A3-4

Combustion air distribution based on observations with periodic or continuous adjustments

Low NOx burners (check if burners are installed)

Automatic O2/CO trim control systems (check if controls are installed)

Monitoring furnace residence time and temperature

Fuel quality and proper fuel handling (including monitoring quality, periodic sampling and analysis, fuel supplier 

certification, if used)

Proper fuel distribution in the combustion zone

Using up to date operating procedures, training, recordkeeping

Maintenance knowledge (including training on applicable equipment and procedures)

Maintenance practices including maintenance procedures and recordkeeping

Fuel/air ratio periodic checks

Inspection and repair of refractories.

Cleaning and inspecting fan housing, blades, and inlet screens.

c. Please classify any good combustion practices performed on this group of process heaters, along with the corresponding frequency of each practice:

Checking all electrical and combustion control systems.

Testing of exhaust gases (CO, CO2, other) as necessary to calculate combustion efficiency and make 

necessary adjustments to the combustion system.

frequency: 2

Inspection and repair of all valves (relief, safety, hydraulic, pneumatic, etc.).

b. Please classify any tune-up practices performed on this group of process heaters along with the corresponding frequency. Tune-up practices include activities that involve checking 

the unit’s combustion processes and adjusting as needed:

Using the scheduled tune-up and procedures provided by the process heater manufacturer.

Inspection and cleaning, as necessary, of fireside and process material-side surfaces.

Inspecting, cleaning and/or reconditioning of fuel systems.

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

30-day rolling average hourly other

Averaging Time 

Spreadsheet Instructions:

Complete this worksheet for each similar group of small gas-fired process heaters. If you have more than one similar group of gas-fired boilers, you may copy and paste this worksheet to document each 

unique group of units. To copy and paste a worksheet, follow these steps: 

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 

2. In the pop-up window, check the box next to "Create a copy" 

3. Under "Before Sheet", select the name of the current sheet you are working in 

4. Click OK. 

5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet. 

The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete,

e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com.
Survey Question: Part II.A Questions 3 and 4 (Questions on this worksheet start on page 5 of the survey overview document) ICR Num

Worksheet Title: Link to Emission Test Data and CEM Data for Small Gas-fired* Process Heaters OMB Control Number

EPA Form N

Who Should 

Complete this 

Spreadsheet? Facilities that have small gas-fired* process heaters

Expiration Date: 

Spreadsheet 

Instructions:

This page provides an overview of the two linked spreadsheets that you will use to provide emissions test data and CEM data. After clicking on the links below, you will download the spreadsheets and complete them for each similar group of small gasfired boilers or process heaters.

You may copy and paste this worksheet for additional boiler groups.

Facility Name (name of facility will automatically be linked to the name you provided in Part I): facility name here

http://survey.erg.com/ss/wsb.dll/s/7g8d/SmallGasEmissionsTestSpreadsheet.xlshttp://survey.erg.com/ss/wsb.dll/s/7g8d/SmallGasCEMSSpreadsheet.xlsIf yes to Question 5, proceed to Worksheet Part II.B.1-2.II.A Design, Operating, Air Pollution Control Device, and Emission Data for Small Gas-Fired* Boilers or Process HeatersIf no to Question 5, you are done with the survey. Please review your answers and submit your response to combustionsurvey@erg.com by the dlisted in the Section 114 letter.

EPA is not requesting actual test reports at this time; however we reserve the right to request actual copies in the future. EPA will also accept other supporting etest data to document any earlier emission tests on the unit with similar controls and fuels. You may also submit a spreadsheet of any other information available to trials or tests of emission control methods or R&D efforts. The Agency is requesting these data only as they may already be available; no additional sampling analyses are required to provide these data. The answer key for providing emission test data from small gas-fired* boilers and process heaters is available at thSite: 3. For each small gas-fired* boiler or process heater, provide the results of the most recent stack test data for each of the pollutants listed in the emistest spreadsheet by completing the spreadsheet linked below. 4. For each small gas-fired* boiler or process heater provide the daily averages of continuous emissions monitor (CEM) data for CO and appropriate adjustments for O2 or other diluent gas. EPA is also requesting corresponding CEM data for NOx in order to evaluate the relationship of low NOx unCO emissions.If available, these data are requested for the most recent 30 days of operation, and the highest single daily average for CO emissions within the most recent cal

of CEM data. You should exclude data from the averages if they are from periods of start-up, shutdown, or malfunctions. The answer key for providing CEM datavailable at this Web-site:5. Do you have any boilers, process heaters, incinerators, or other combustion units at your facility (excluding small gas-fired boilers or process hea

Yes

Any other combustion units?

No
ICR Number 2286.01

OMB Control Number: 2060-0616

Expiration Date: 08/31/2011

Survey Question: ICR Number 2286.01

Worksheet Title:Unit Design, and Operating Data OMB Control Number: 2060-0616

EPA Form No. 5900-122

Who Should Complete this Spreadsheet? Expiration Date: 08/31/2011

1. General Information

facility name here

a. Combustion device ID:

b. Year built: (YYYY)

c. Design capacity (heat input) value:

d. Fuel type associated with design capacity (heat input) value:

If other, please specify:

e. Design capacity units:

If other, please specify:

f. Furnace heat release rate (Btu/ft3):

g. Is the unit subject to NSPS?

h. If yes, indicate the year of NSPS:

i. Primary use of combustion device (check all that apply):

steam generation

space heat

process heat

electricity generation

waste incineration

cogeneration

Other (please explain):

j. Additional uses of combustion device (check all that apply):

steam generation

space heat

process heat

electricity generation

waste incineration

cogeneration

Other (please explain):

k. For boilers only, check all that apply (several may apply to your unit):

k.1 Erection Design

Package (shop erected)

Field Erected

Modular (part shop erected and part field erected)

k.2 Unit Design

Water tube

Fire tube

Hybrid (if hybrid is selected, check the appropriate subtype)

main combustion zone design is watertube

main combustion zone design is firetube

k.3 Suspension Firing

tangential

wall-fired

Part II.B Questions 1 and 2 

(Questions on this worksheet start on page 6 of the survey overview document)

Facility that has any boilers*, process heaters*, or other combustion units* that do not qualify as small gasfired* boilers and process heaters or incinerators*

Facility Name: (name of facility will automatically be linked to the name you provided in Part I)

Yes

No

Subject to NSPS 

(select)

Spreadsheet Instructions:

Complete this worksheet for each individual combustion unit. Sections II.B through II.C have been designed to request answers about a particular combustion unit before moving on to other combustion units at the 

facility. Once you complete this question sequence for one unit, you will repeat the question sequence for other units. To repeat the question sequence, you may copy and paste this worksheet to document each 

unique unit. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 

2. In the pop-up window, check the box next to "Create a copy" 

3. Under "Before Sheet", select the name of the current sheet you are working in 

4. Click OK. 

5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete, e-mail this spreadsheet along with 

all other completed spreadsheets to: combustionsurvey@erg com
ICR Number 2286.01

OMB Control Number: 2060-0616

Expiration Date: 08/31/2011

combination of suspension firing and grate firing (i.e., oil and bark)
ICR Number 2286.01

OMB Control Number: 2060-0616

Expiration Date: 08/31/2011

other (please explain)

l. For solid-fuel* boilers only, check all that apply (several may apply to your unit):

Stoker:

spreader

mass feed

manual feed

other (please specify):

Fluidized Bed:

circulating

bubbling

Pulverized Coal

Cyclone

Other:

fuel cells

suspension burners

sloped-grate

dutch oven

gasifier

Other not listed (please specify):

m. For process heaters* only, check all that apply:

Erection Design:

Package (shop erected)

Field Erected

Unit Design:

Fire tube

Water tube

Thermal oil heaters

Other (please explain):

 Firing Mechanism 

Fuel cells

Suspension burners

Sloped-grate

Dutch oven

Gasifier

Other not listed (please specify):

n. For other combustion units* only, check all that apply:

Draft Configuration:

Natural draft

Forced draft

Unit Type:

Dryer

Kiln

Heater

Engine

Other not listed (please specify):

2. Operating Parameters

a. Hours of Operation (hr/yr) Typical:

 (hours per year excludes periods of start-up, shutdown, and malfunction)

b. Duty Cycle:

c. Is the operation seasonal*?

Now Proceed to Worksheet Part II.B.3a

Base-loaded

Load following

Standby

Duty Cycle

Yes

No

Seasonal 
Survey Question: ICR Number 2286.01

Worksheet Title:

Who Should Complete this Spreadsheet?

3. Air Pollution ControlFacility Name (from Part I): Combustion device ID:a1. Control device currently installed:

a2. Year control device installed:

a3. Has an upgrade/ modification been made to the control device since it was installed?

a4. Was an upgrade/ modification/ installation/ replacement of this control device made in order to comply with the now vacated 40 CFR 63 Subpart DDDDD? (If no, skip to a9.)

a5. If yes to a4, was the prior control device removed, added to, or modified to the current control device?

a6. If yes to a4, what was the control device prior to the upgrade/modification/installation/replacement made in preparation of compliance with 40 CFR 63 Subpart DDDDD?

a7. If yes to a4, provide the month and year that the upgrade/ modification/ replacement to the control device was made:

a8. If yes to a4, provide the date when the control device selected in a6 was installed or last upgraded/ modified(whichever date is most recent):

a9. Is the control device used as a common control device for more than one combustion unit?

a10. What, if any, Continuous Parameter Monitoring Systems (CPMS)* are installed for this control device? (check all that apply)

If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

Specify the control device type using the descriptions provided in the drop-down menus. 

facility name herePart II.B Question 3a(Questions on this worksheet start on page 8 of the survey overview document)Add-On Air Pollution Control Device DataFacility that has any boilers*, process heaters*, or other combustion units* that do not qualify as small gas-fired* boilers and process heaters or incinerators*

OMB Control Number:2060-0616EPA Form No. 5900-122

a. In the matrix below, please list all add-on control devices, in the order contacted by the exhaust. 

You will identify good combustion practices used and combustion controls in the next worksheet, II-B.3b-4.

2nd 

Control 

Device:

1st 

Control 

Device:

year2year1

mm/yyyy mm/yyyymm/yyyy mm/yyyy

Your responses should include information devices considered integral to your combustion unit (such as mechanical collectors) as well as add-on control devices.You will first be asked to list all control devices, in the order contacted by the exhaust, and then you will be asked to identify good combustion practices used, followed by combustion controls. 

Expiration Date: 08/31/2011

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units):

(select) (select)

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units):

(select) (select)

RemovedAdded to

Prior device 

Modified

RemovedAdded to

Prior device 

Modified

none installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control devicenone installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control device

Spreadsheet Instructions:Complete this worksheet for each individual combustion unit. Sections II.B through II.C have been designed to request answers about a particular combustion unit before moving on to other combustion units at the facility. Once you complete this question sequence for one unit, you will repeat the question sequence for other units. To repeat the question sequence, you may copy and paste this worksheet to document each unique unit. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 2. In the pop-up window, check the box next to "Create a copy" 3. Under "Before Sheet", select the name of the current sheet you are working in 4. Click OK. 5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to: combustionsurvey@erg com
a1. Control device currently installed:

a2. Year control device installed:

a3. Has an upgrade/ modification been made to the control device since it was installed?

a4. Was an upgrade/ modification/ installation/ replacement of this control device made in order to comply with the now vacated 40 CFR 63 Subpart DDDDD? (If no, skip to a9.)

a5. If yes to a4, was the prior control device removed, added to, or modified to the current control device?

a6. If yes to a4, what was the control device prior to the upgrade/modification/installation/replacement made in preparation of compliance with 40 CFR 63 Subpart DDDDD?

a7. If yes to a4, provide the month and year that the upgrade/ modification/ replacement to the control device was made:

a8. If yes to a4, provide the date when the control device selected in a6 was installed or last upgraded/ modified(whichever date is most recent):

a9. Is the control device used as a common control device for more than one combustion unit?

a10. What, if any, Continuous Parameter Monitoring Systems (CPMS)* are installed for this control device? (check all that apply)

3rd 

Control 

Device: If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

4th 

Control 

Device: If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

5th 

Control 

Device: If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

6th 

Control 

Device: If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

7th 

Control 

Device: If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

8th 

Control 

Device: If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

9th 

Control 

Device: If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

10th 

Control 

Device: If 'other' control device is selected, please specify: If 'other' control device is selected, please specify:

mm/yyyy

mm/yyyymm/yyyy

year8year7year9

year10 mm/yyyy

mm/yyyy

mm/yyyy mm/yyyymm/yyyy

mm/yyyy

mm/yyyy mm/yyyy

mm/yyyy

mm/yyyymm/yyyymm/yyyy mm/yyyy

year6year4year5year3 Yes

No

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units):

(select) (select)

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units):

(select) (select)

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units):

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units):

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units):

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units)

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units)

YesNo

Upgrade 

YesNo (go to a9)

DDDDD Upgrade Common Control Device 

Not CommonYes (Please specify units)

(select)(select)(select)(select)(select)(select)

(select)(select)(select)(select)(select)(select)

RemovedAdded to

Prior device 

ModifiedRemovedAdded to

Prior device 

ModifiedRemovedAdded to

Prior device 

ModifiedRemovedAdded to

Prior device 

ModifiedRemovedAdded to

Prior device 

ModifiedRemovedAdded to

Prior device 

ModifiedRemovedAdded to

Prior device 

ModifiedRemovedAdded to

Prior device 

Modified

none installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control devicenone installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control devicenone installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control devicenone installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control devicenone installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control devicenone installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control devicenone installedpressure dropflow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control devicenone installedpressure drop flow rate entering or exiting the control deviceOther (Please specify):Voltage and secondary current (or total power input) to the control device
ICR Number 2286.01

OMB Control Number: 2060-0616

Expiration Date: 08/31/2011

Survey Question: ICR Number 2286.01

Worksheet Title: OMB Control Number: 2060-0616

EPA Form No. 5900-122

Who Should

Complete this

Spreadsheet?

Expiration Date: 08/31/2011

3. Air Pollution Control

Facility Name (from Part I): facility name here Combustion device ID:

b. Is oxygen or carbon monoxide used for boiler/process heater combustion air trim control?

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

frequency:

4. Stack

a. Does combustion unit emit through its own single stack*? 

b. Does combustion unit emit through a common stack*?

c. Does combustion unit emit through multiple stacks*?

Part II.B Questions 3b, c, d and 4

(Questions on this worksheet start on page 9 of the survey overview document)

Combustion air distribution based on observations with periodic or

continuous adjustments

Monitoring furnace residence time and temperature

Automatic O2/CO trim control systems (check if installed)

Fuel/air ratio periodic checks

Cleaning and inspecting fan housing, blades, and inlet screens

Using up to date operating procedures, training, recordkeeping

Cleaning/reconditioning and inspecting the feedwater system

Fuel quality and proper fuel handling (including monitoring quality, periodic sampling and 

analysis, fuel supplier certification, if used)

d. Please classify any good combustion practices performed on this combustion unit, along with the corresponding frequency (i.e., daily, monthly, quarte

semiannually, annually, every two years, every five years or longer) of each practice:

Facility that has any boilers*, process heaters*, or other combustion units* that do not qualify as small gas-fired* boilers and process 

heaters or incinerators*

combustion of drier fuel (check if practice is used)

If this option is checked, indicate what level the CO is adjusted to:

Inspection and repair of all valves (relief, safety, hydraulic, pneumatic, etc.)

Combustion Controls and Good Combustion Practices Air Pollution Control Device Data

Maintenance practices including maintenance procedures and recordkeeping

Maintenance knowledge (including training on applicable equipment and procedures)

Using the scheduled tune-up and procedures provided by the boiler manufacturer

Inspection and cleaning, as necessary, of fire-side, water-side, and/or process material 

side surfaces

Inspecting, cleaning and/or reconditioning of fuel systems

Checking all electrical and combustion control systems

Testing of exhaust gases (CO, CO2, other) as necessary to calculate combustion

efficiency and make necessary adjustments to the combustion system. 

Inspection and repair of refractories

Now Proceed to Worksheet Part II-C

b1. If yes to b, list quantity and category of all other combustion units venting to this common stack:

 (example: 2 coal fired boilers venting to common stack)

Proper liquid atomization

co-firing (check if co-firing is used to improve combustion)

low NOx burners (check if installed)

Proper fuel distribution in the combustion zone

fly ash reinjection (check if reinjection is used)

better fuel distribution in firebox (check if fuel distribution is adjusted)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

(select)

Yes No 

Own Stack

Yes No 

Common Stack

Yes No 

Multiple Stacks

Spreadsheet Instructions:

Complete this worksheet for each individual combustion unit. Sections II.B through II.C have been designed to request answers about a particular combustion unit before moving on to other 

combustion units at the facility. Once you complete this question sequence for one unit, you will repeat the question sequence for other units. To repeat the question sequence, you may copy and 

paste this worksheet to document each unique unit. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 

2. In the pop-up window, check the box next to "Create a copy" 

3. Under "Before Sheet", select the name of the current sheet you are working in 

4. Click OK. 

5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete, e-mail this 

spreadsheet along with all other completed spreadsheets to: combustionsurvey@erg.com

c. Please classify any tune-up practices performed on this combustion unit along with the corresponding frequency (i.e., daily, monthly, quarterly, 

semiannually, annually, every two years, every five years or longer). Tune-up practices include activities that involve checking the unit’s 

combustion processes and adjusting as needed:
Survey 

Question:

Worksheet Title:

Who Should 

Complete this 

Spreadsheet?

Facility that has any boilers*, process heaters*, or other combustion units* that do not qualify as small gas-fired* boilers and process heaters or incinerators*

Facility Name: facility name here Combustor ID:

You will be asked to enter each fuel/material combusted in the combustion unit in the following order:

 Start-up* fuel/material

 Individual and co-fired fuels/material combusted during normal operation Additional Fuels/Materials that are not routinely combusted (including fuels that are fired on an intermittent basis)

1. If start-up* fuel is different than normal fuel, please answer question 1 parts a, b, and c, otherwise proceed to question 2:

a. Select start-up* fuel/material:

If 'other' is selected for start-up fuel, please specify:

b. Number of start-ups per yearc. Typical length of time for start-up (hours) 

2. Fuels/Materials Combusted During Normal Operation:

Heat Input (mmBtu/hr) 

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Part II.C Questions 1 to 5(Questions on this worksheet start on page 10 of the survey overview document)Fuels/Materials burned in the Combustion Unit

(select)

Spreadsheet Instructions:Complete this worksheet for each individual combustion unit. You may reference Appendix C of the survey overview document to identify what fuel category your specific fuel type belongs to. Sections II.B through II.C have been designed to request answers about a particular combustion unit before moving on to other combustion units at the facility. Once you complete this question sequence for one unit, you will repeat the question sequence for other units. To repeat the question sequence, you may copy and paste this worksheet to document each unique unit. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 2. In the pop-up window, check the box next to "Create a copy" 3. Under "Before Sheet", select the name of the current sheet you are working in 4. Click OK. 5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to: combustionsurvey@erg com

Please complete the table below in the answer key for each fuel or combination of fuels fired in the combustion unit. You will provide the name of the material, the minimum, maximum and annual or seasonal average heat input of the fuel used in the combustion unit. In the example below, this boiler fires bituminous coal, and plant-based agricultural residue. The agricultural residue is fired seasonally. Use the fuel categories from the dropdown menus to respond. Select the fuel category that is most specific to your fuel/material based on the table in Appendix C of the survey overview document. For example, "landfill gas (LFG)" is more useful than "waste-gas"; "bituminous coal" or "anthracite coal" is more useful than "coal". If you specific fuel type is not listed in Appendix C, then you should select “other solid”, “other liquid”, or “other gas” and provide a brief name for the specific fuel type. 
Min Max Me

 2a. 2b. 2c. 2d. 2e. 2f. 2

Example:

Bituminous Coal B A 8200 100 175 11

Plant- Based Agricultural Residue B S 1000 25 50 32

If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:

6th Fuel:

5th Fuel:4th Fuel:

3rd Fuel:

2nd Fuel:

1st Fuel:

Is fuel/material fed 

directly to boiler (B), 

process heater (P), 

other combustion unit 

(O)

or fed to a gasifier 

located upstream (G)?

Is this fuel/ material 

used seasonally (S)* 

or annually (A)? 

Hours used 

Fuel/Material per year

5612346

7th Fuel:

6

8th Fuel:

6

9th Fuel:

6

10th Fuel:

(select)(select)(select)(select)(select)(select)(select)(select)(select)(select)
If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:

3. Fuels/Materials NOT Routinely Combusted (including fuels that are fired on an intermittent basis)

Min Max Me

 3a. 3b. 3c. 3d. 3e. 3f. 3

Example: 

Wood: Unadulterated Timber B 

Agricultural 

residue is 

unavailable during 

part of seasonal 

operation 200 25 50 38

If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:

2nd Fuel

(not routinely 

combusted):

1st Fuel

(not routinely 

combusted):

Describe 

Conditions for 

Fuel Use

Hours used 

per year

Please complete the table below in the answer key. This table is similar to question 2 above, however it applies to fuels/materials NOT routinely fired in the combustion unit.An example response is shown below.

Heat Input (mmBtu/hr) 

Is fuel/material fed 

directly to boiler (B), 

process heater (P), 

other combustion unit 

(O)

or fed to a gasifier 

Fuel/Material located upstream (G)?

6

11th Fuel:

6

12th Fuel:

6

13th Fuel:

6

14th Fuel:

6

15th Fuel:

(select)(select)(select)(select)(select)(select)(select)
If 'other' fuel type is selected, please specify below:

3rd Fuel

(not routinely 

combusted):

(select)
If 'other' fuel type is selected, please specify below:If 'other' fuel type is selected, please specify below:

4b. If yes to question 4a above, please list where the available test report occurred not the equipment arrangement:

5a. Is CEM Installed for this pollutant?

5b. Is CEM Installed 

for Regulatory 

Purposes?

5c. Can CEM data 

be recorded? 

5d. Can CEM 

data be 

saved?

SO2

NOx

CO

O2 (or other diluent gas)

PM

VOC or hydrocarbon monitor

5. Answer the following questions for each continuous emission monitor (CEM)* installed on this unit:4a. Do you have an emission test report available for this unit? (EPA is not requesting actual test reports at this time; however we reserve the right to request actual copies in the future.) 

Now Proceed to Worksheet Part II-C.6-10

4th Fuel

(not routinely 

combusted):

5th Fuel

(not routinely 

combusted):

Yes No

Emission Test Available 

dedicated control device, single dedicated stackcommon control device, single stackdedicated control device, multiple stackscommon control device, multiple stacks

Test Location 

Other (please explain):

(select)(select)
Survey Question: Part II-C Questions 6 to 11

(Questions on this worksheet start on page 11 of the survey overview

document)

Worksheet Title: Fuels/Materials burned in the Combustion Unit

Who Should Complete this Spreadsheet?

Facility Name: facility name here

Combustor ID:

6. Does this boiler, process heater, or other combustion unit at your facility fire any non-fossil or other* fuels/materials?(a) Select non-fossil fuel from list

OMB 

(Please answer questions 7 and 8 separately for each non-fossil fuel burned. Your answers for questions 7 to 9 are non-binding.)

Facility that has any boilers*, process heaters*, or other combustion units* that do not qualify as small gas-fired* heaters or incinerators*

p g y p ( ) ( ), pp

YesNo (Skip to question 9)

Non-fossil or other* fuels/materials

Spreadsheet Instructions:Complete this worksheet for each individual combustion unit. You may reference Appendix C of the survey overview document to identify what fuel category your specific fuel type bdesigned to request answers about a particular combustion unit before moving on to other combustion units at the facility. Once you complete this question sequence for one unit, yunits. To repeat the question sequence, you may copy and paste this worksheet to document each unique unit. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 2. In the pop-up window, check the box next to "Create a copy" 3. Under "Before Sheet", select the name of the current sheet you are working in 4. Click OK. 5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete, ecompleted spreadsheets to: combustionsurvey@erg.com 
If 'other' fuel type is selected, please specify below: If 'other' fuel type is selected, please specify below: If 'other' fuel type is selected, please spec

If 'other' alternative handling method, please specify below: If 'other' alternative handling method, please specify below: If 'other' alternative handling method, pl

8. If the unit were to stop burning this non-fossil or other* fuel/material in your combustion unit(s), how would you compensate for the lost heating value? (b) Check corresponding alternative method(s) for handling this non-fossil fuel or other material.

Would your boilers or process heaters likely stop combusting these non-fossil or other materials if continuing to burn these materials would result in the unit being subject to 129 in

(select)

3rd non-fossil fuel:

Yes No

1st non-fossil fuel

Unknown Yes No

2nd non-fossil fuel 

Unknown Yes No

3rd non-fossil fuel Alternative Disposal Method - 3rd non-fossil f

Send to a landfill off-siteDispose through local trash collectionVent to atmosphereSend to waste water treatment plantContract for special disposal serviceSell to a processor for making a producSell to off-site facility for use as a fuelDispose on-siteStop purchasing material from 3rd partyDon't knowNo other alternative currently availableShut down facilityother (please specify):

1st non-fossil fuel

(select)

2nd non-fossil fuel (select)

3rd non-fossil fuel 

(select)

(select)

1st non-fossil fuel:

(select)

2nd non-fossil fuel:

Alternative Disposal Method - 1st non-fossil fuel 

Send to a landfill off-siteDispose through local trash collectionVent to atmosphereSend to waste water treatment plantContract for special disposal serviceSell to a processor for making a productSell to off-site facility for use as a fuelDispose on-siteStop purchasing material from 3rd partyDon't knowNo other alternative currently availableShut down facilityother (please specify):

Alternative Disposal Method - 2nd non-fossil fuel 

Send to a landfill off-siteDispose through local trash collectionVent to atmosphereSend to waste water treatment plantContract for special disposal serviceSell to a processor for making a productSell to off-site facility for use as a fuelDispose on-siteStop purchasing material from 3rd partyDon't knowNo other alternative currently availableShut down facilityother (please specify):
10. Sections II.B and II.C are now complete for this Combustion Unit ID.Do you have another boiler, process heater, or other combustion unit you need to add to this survey?If Yes, re-start at part II.B Otherwise proceed to part II.D.9. What additional annualized costs would you incur for this unit to comply with Section 129 CISWI rule as compared to the vacated Boiler MACT? Your answer is non-binding.(b) Indicate the cost components evaluated in your cost estimate range provided in question 13a:(a) Choose appropriate cost range.

Yes No

Another Combustion Unit? 

(select)
Survey 

Question:

Worksheet 

Title:

Who Should 

Complete this 

Spreadsheet?

Spreadsheet 

Instructions:

Now Proceed to Worksheet Part III

1. Provide the results of the most recent stack test data for each of the pollutants listed in the emission test spreadsheet by completing ancombustionsurvey@erg.com. EPA is not requesting actual test reports at this time; however we reserve the right to request actual copieemission test data to document any earlier emission tests on the unit with similar controls and fuels. You may also submit a spreadsheet tests of emission control methods or R&D efforts. The Agency is requesting these data only as they may already be available; no additiodata. The answer key for providing emission test data is available at this Web-site: 2. Provide the daily averages of continuous emissions monitor (CEM) data for NOx, SO 2, CO, O2 (or other diluent gas), PM and 6-minute 

30 days of operation, and the highest single daily average (highest single 6-minute average for opacity) data point within the most recent from the averages if they are from periods of start-up, shutdown, or malfunctions. You can submit this data by completing the CEM data scombustionsurvey@erg.com. The answer key for providing CEM data is available at this Web-site: 

http://survey.erg.com/ss/wsb.dll/s/7g8d/EmissionTestSpreadsheet.xls3. Provide a summary of permitted or regulatory emission limits, if applicable to your unit for each pollutant listed in the Permitted and Renot have a limit for a given unit, you may leave this entry blank. You can submit this data by completing the permitted and regulatory sprecombustionsurvey@erg.com. The answer key for providing permitted and regulatory limits is available at this Web-site:http://survey.erg.com/ss/wsb.dll/s/7g8d/CEMSSpreadsheet.xlshttp://survey.erg.com/ss/wsb.dll/s/7g8d/PermittedandRegulatoryLimits.xls

This page provides an overview of the three linked spreadsheets that you will use to provide emissions test data, CEM and Regulatory and permitted emission limits. After clicking on the links below, you will download the spreadsheets ancomplete them for each similar group of small gas-fired boilers or process heaters.Facility that has any boilers*, process heaters*, or other combustion units* that do not qualify as small gas-fboilers and process heaters or incinerators*Link to Emission Test Data, CEM Data and Permitted and Regulatory Limit DataPart II.D(Questions on this worksheet start on page 13 of the survey overview document)
Survey Question: Part III

(Questions on this worksheet start on page 13 of the survey overview 

ICR Numbe

Worksheet Title: Fuel/Material Data and Link to Fuel Analysis Spreadsheet OMB Contro

2

EPA Form No

Who Should Complete this Spreadsheet? Facility that has any boilers*, process heaters*, or other combustion units* 

that do not qualify as small gas-fired* boilers and process heaters or incinerators*

Expira

0

http://survey.erg.com/ss/wsb.dll/s/7g8d/FuelAnalysis.xls

Facility Name: facility name here

1. Fuel/Material Description

(make selections consistent with fuel/material in Part II.C.2.) 2. Where does fuel/material originate?

3. Is a fuel/m

analysisprovide

supplier or cond

site availa

If 'other' fuel is selected, please specify:If 'other' fuel is selected, please specify:

1st Fuel:

2nd Fuel:

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

(select)(select)

Spreadsheet Instructions:This page asks basic questions about any of the fuels (excluding natural gas, propane, liquefied petroleum gas, and refinery gas) burned in any of the boilers, process heaters, or otheboilers, process heaters, or other combustion units other than small gas-fired boilers or process heaters covered under survey Part II.A or incinerators covered under survey part IV bu10 fuels listed above, you may copy and paste this worksheet to answer questions about these fuels. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 2. In the pop-up window, check the box next to "Create a copy" 3. Under "Before Sheet", select the name of the current sheet you are working in 4. Click OK. 5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.For Question 3 below: If you have a fuel/material analysis available, provide the results of the most recent fuel/materials analysis for all fuels and materials (excluding natural gas, pro

and refinery gas) combusted on-site in combustion units. Use the fuel categories from the list below, when available. Select the ‘other’ fuel description only if the fuel burned in the unitselected please provide a brief name for this fuel. Select the most descriptive name as possible. For example, "landfill gas (LFG)" is more useful than "waste-gas"; "bituminous coal" othan "coal". Please e-mail an electronic copy of the fuel analysis to combustionsurvey@erg.com. The fuel analysis should be formatted according to the linked Excel spreadsheet below. Please idand combustor ID consistently with how you answered Parts I and II. You may also provide a summary of any earlier fuel analyses, as long as these are representative of fuels/materiheater. The answer key for providing fuel analysis data is available at this Web-site:
1. Fuel/Material Description

(make selections consistent with fuel/material in Part II.C.2.) 2. Where does fuel/material originate?

3. Is a fuel/m

analysisprovide

supplier or cond

site availa

If 'other' fuel is selected, please specify:If 'other' fuel is selected, please specify:If 'other' fuel is selected, please specify:If 'other' fuel is selected, please specify:If 'other' fuel is selected, please specify:If 'other' fuel is selected, please specify:If 'other' fuel is selected, please specify:

10 If 'other' fuel is selected, please specify: th Fuel:

Now Proceed to Worksheet Part IV.A.1

3rd Fuel:

4th Fuel:

5th Fuel:7th Fuel:6th Fuel:8th Fuel:9th Fuel:

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

(select)(select)(select)(select)(select)(select)(select)(select)

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

On-site* Off-siteBoth (i.e., some bark from on-site combined with some bark generated off-site)

Origin of Fuel 

YesNo

Analysis Availab

If any of your boilers, process heaters, or other combustion units other than small gas-fired boilers or process heaters covered under survey Part II.A or incinerators covered under survey part IV burn any other fuels other than the 10 fuels listed above, you may copy and paste this worksheet to answer questions about these fuels. Follow the Spreadsheet Instructions box to copy this worksheet.
ICR Number 2286.01

OMB Control Number: 2060-0616

Expiration Date: 08/31/2011

Survey Question:

Worksheet Title: Incinerator Data

Who Should Complete this 

Spreadsheet?

1. Unit Data

Facility Name (from Part I): facility name here

a. Combustion device ID:

b. Unit Design Information (check all that apply):

single batch fed

starved air

fixed hearth

rotary hearth

intermittent batch fed

excess air

rotary kiln

moving grate

continuously fed

single chamber

multi-chamber/afterburner

spreader stoker

other (please specify)

c. Manufacturer: 

d. Model Number: 

e. Installation Date: 

f. Dates/descriptions of major renovations: 

g1. Design Capacity: 

g2. Design Capacity Units: 

units, if other:

h1. Typical Hours Operated, Per Year: 

h2. Typical Hours Per day: 

Now Proceed to Worksheet Part IV.A.2

Part IV Question 1

(Questions on this worksheet start on page 14 of the survey overview document)

Facility that has any incinerators*

ICR Number 2286.01

OMB Control Number: 

2060-0616

EPA Form No. 5900-122

Expiration Date: 

08/31/2011

Tons of waste per day

Other (please specify):

Design Capacity Units 

Spreadsheet Instructions:

Complete this section for each incinerator* at your facility. If you do not have any incinerators at your facility, you are done with the survey. Please review your answers and submit your 

response to EPA by the deadline listed in the Section 114 letter. If you have more than one incinerator at your facility, you will repeat the question sequence for other incinerators. To repeat 

the question sequence, you may copy and paste this worksheet to document each unique unit. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 

2. In the pop-up window, check the box next to "Create a copy" 

3. Under "Before Sheet", select the name of the current sheet you are working in 

4. Click OK. 

5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have 

been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete, e-mail this 

spreadsheet along with all other completed spreadsheets to: combustionsurvey@erg.com 
Survey Question:

Worksheet Title: Air Pollution Control Device and Equipment Modifications at Incinerators

Who Should 

Complete this 

Spreadsheet?

Facility Name: facility name here Combuster ID:

Type: 

Year Installed: Manufacturer: Model No.: 

Percent of incinerator operating time that control device is operated:

Control device air flow capacity (typically in acfm): 

Date control device(s) were last modified, repaired, or rebuilt (mm/yyyy): 

Annual hours ofcontrol device downtime for repairs and maintenance: Is control device shared with other equipment?

Winscode

 Question#: a1. a2. a3. a4. a5. a6. a7. a8. a9. 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

2. Air Pollution Control Device and Equipment Modifications Information1st Control Device:

(a) Is your incinerator equipped with an air pollution control device (e.g. wet scrubber, fabric filter, electrostatic precipitator)?

If yes, please specify the type and provide any details as specified below for each control device:

mm/yyyy 0.00 

0.00 0.00 mm/yyyy 0.00 0.00 0.000.00 0.00 mm/yyyy 0.00 

2nd Control Device:

3rd Control Device:

Part IV Question 2(Questions on this worksheet start on page 14 of the survey 

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facility that has any incinerators*

Yes

Shared control device

No (select) 

Yes

Shared control device

No (select) 

Yes

Shared control device

No (select) 

Spreadsheet Instructions:Complete this section for each incinerator* at your facility. If you do not have any incinerators at your facility, you are done with the survey. Please review your answers and submit your response to EPA by the deadline listed in the Section 114 letter. If you have more than one incinerator at your facility, you will repeat the question sequence for other incinerators. To repeat the question sequence, you may copy and paste this worksheet to document each unique unit. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 2. In the pop-up window, check the box next to "Create a copy" 3. Under "Before Sheet", select the name of the current sheet you are working in 4. Click OK. 5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to: combustionsurvey@erg.com 
Type: 

Year Installed: Manufacturer: Model No.: 

Percent of incinerator operating time that control device is operated:

Control device air flow capacity (typically in acfm): 

Date control device(s) were last modified, repaired, or rebuilt (mm/yyyy): 

Annual hours ofcontrol device downtime for repairs and maintenance: Is control device shared with other equipment?

Winscode

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

If 'other' control device is selected, please specify:

If yes, please identify the other equipment that is routed to the same control device: 

Now Proceed to Worksheet Part IV.A.3-5

0.00 0.00 mm/yyyy 0.00 

6th Control Device:

0.00 0.00 mm/yyyy 0.00

0.00 

0.00 0.00 mm/yyyy 0.000.00 0.00 mm/yyyy

10th Control Device:

4th Control Device:

5th Control Device:

0.00 0.00 mm/yyyy 0.00 

7th Control Device:

0.00 0.00 mm/yyyy 0.00 

9th Control Device:

0.00 0.00 mm/yyyy

8th Control Device:

0.00

Yes

Shared control device

No 

Yes

Shared control device

No 

Yes

Shared control device

No 

Yes

Shared control device

No (select) 

Yes

Shared control device

No (select) 

Yes

Shared control device

No 

Yes

Shared control device

No

(select)(select)(select)(select)(select) 
ICR Number 2286.01

OMB Control Number: 2060-0616

Expiration Date: 08/31/2011

Survey Question:

Worksheet Title: Waste Segregation or Recycling Practices at Facilities with Incinerators

Who Should Complete this

Spreadsheet?

3. Waste Segregation or Recycling Practices

Facility Name (from Part I): facility name here

a. Combustion device ID:

a. Does the facility currently employ waste segregation or recycling practices that reduce the volume of waste being incinerated? 

b. When were waste segregation 

practices begun? (mm/yyyy)

c. What types of materials are segregated from the waste stream? (please check all that apply)

paper/cardboard

glass

plastics

batteries

fluorescent light bulbs

other metal containing materials 

(please list):

other chlorine containing materials 

(please list):

other (please list):

d. What is done with the materials that are segregated from the waste stream?

e. Estimate the current cost of your waste segregation/recycling program (please indicate whether cost estimate is per month, quarter, or year).

per

4. Emission Test Data

a. Has emissions testing ever been conducted on this unit?

5. Do you have another incinerator unit you need to add to this survey?

Part IV Questions 3, 4 and 5

(Questions on this worksheet start on page 15 of the survey 

ICR Number 2286.01

OMB Control Number: 

2060-0616

EPA Form No. 5900-122

Expiration Date: 

08/31/2011

Facility that has any incinerators*

Yes

Waste Segregation or Recycling

No (go to question 4.)

Yes

Emissions Data on Waste Segregation

No

(select)

Yes

Emissions Tests

No

Yes No

Another Incinerator Unit?

Spreadsheet Instructions:

Complete this section for each incinerator* at your facility. If you do not have any incinerators at your facility, you are done with the survey. Please review your answers and submit 

your response to EPA by the deadline listed in the Section 114 letter. If you have more than one incinerator at your facility, you will repeat the question sequence for other 

incinerators. To repeat the question sequence, you may copy and paste this worksheet to document each unique unit. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet... 

2. In the pop-up window, check the box next to "Create a copy" 

3. Under "Before Sheet", select the name of the current sheet you are working in 

4. Click OK. 

5. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

The facility ID will automatically be linked to the new worksheet, based on your response in Part I. Please indicate a new combustor ID in each copied worksheet. When complete, email this spreadsheet along with all other completed spreadsheets to: combustionsurvey@erg.com 

f. Do you have any emissions test data that would show the effects of segregating materials from the waste stream (e.g., test data before and after 

waste segregation practices began)? If yes, please mail complete copies of the test reports and any analyses of the impact of waste segregation on 

emissions to the EPA address provided in your Section 114 letter.

If Yes, repeat part IV for another unit by following the copy paste instructions at the top of this sheet. Otherwise you are done with the survey. Please 

review your answers and submit your response to EPA by the deadline listed in the Section 114 letter.

b. If so, please provide complete copies of the test reports that document all emission testing that has been conducted in the last 10 years. You may provide 

electronic versions of the test reports in lieu of mailing paper copies to the EPA address provided in your Section 114 letter.
Survey Question: Part II.A Question 3 (Questions on this worksheet start on page 5 of the survey overview document)

Worksheet Title: Organic HAP and CO Emission Test Data for Small Gas-Fired* Boilers or Process HeatersWho Should Complete this Spreadsheet? Facilities with small gas-fired* boilers or process heatersFacility Name:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information ythink is necessary about this test repo

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)(select fuel type) (select fuel input units)(select fuel type) (select fuel input units)(select fuel type) (select fuel input units)Emission Dataacetaldehyde (select emission rate units)benzene (select emission rate units)formaldehyde (select emission rate units)toluene (select emission rate units)xylenes (select emission rate units)CO (select emission rate units)

Other Operating Parameters During Test (These parameters are only required if emission units are provided in units of concentration)

Dry or Wet Basis Wet or Dry% O2 or other diluent gas (necessary only if CO emission data is provided)If other diluent gas, please specify gas in this cellExhaust Stream %MoistureExhaust Flowrate acfm or dscfmExhaust Temperature C or F

Notes:

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Peach shaded cells indicate areas where the user will enter a response* Indicates a definition of the term is available in the Survey Overview Document

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Spreadsheet Instructions:You should provide the most recent data available for each pollutant at any similar group of small gas-fired* boilers or process heaters. EPA encourages you to provide the results of more than one test, in order to allow us to assess intra-unit variability. You may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 

Select the applicable gaseous fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. If you combust something other than liquefied petroleum gas, natural gas, propane, or refinery gas in this combustion unit you should enter that emission test data in the spreadsheet associated with survey question II.D. 
Survey Question: Part II.A Question 3 (Questions on this worksheet start on page 5 of the survey overview document)

Worksheet Title: PAH Emission Test Data for Small Gas-Fired* Boilers* or Process Heaters*Who Should Complete this Spreadsheet? Facilities with small gas-fired* boilers or process heatersFacility Name:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location 

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)(select fuel type) (select fuel input units)(select fuel type) (select fuel input units)(select fuel type) (select fuel input units)Emission Data7-PAH* (select emission rate units)15-PAH** (select emission rate units)

Other Operating Parameters During Test (These parameters are only required if emission units are provided in units of concentration)

Dry or Wet Basis Wet or DryExhaust Stream %MoistureExhaust Flowrate acfm or dscfmExhaust Temperature C or F

Notes:Peach shaded cells indicate areas where the user will enter a response* Indicates a definition of the term is available in the Survey Overview Document

ICR Number 2286.01OMB Control Number: 2Expiration Date: 08/31/2

Enter numerical value when available. If the test results are below detection limit, 

please note the detection limit in brackets (e.g., [< 0.010]). 

Spreadsheet Instructions:You should provide the most recent data available for each pollutant at any similar group of small gas-fired* boilers or process heaters. EPA encourages you to provide the results of more than one test, in order tto assess intra-unit variability. You may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserIf you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 

Select the applicable gaseous fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. If you combust something other than liquefied petroleum gas, natural gas, propane, or refinery gas in this combustion unit you should enter that emission test data in the spreadsheet associated with survey question II.D. 

*7-PAH means: benz(a)anthracene, benzo(a)pyrene, benzo(b)fluoranthene, benzo(k)fluoranthene, chrysene, dibenz(a,h)anthracene, and indeno(1,2,3-cd)pyrene** 15-PAH means acenaphthene, acenaphthylene, anthracene, benzo(a)anthracene, benzo(a)pyrene, benzo(b)fluoranthene, benzo(g,h,i)perylene, benzo(k)fluoranthene, dibenzo(a,h)anthracene, dibenzofuran, fluoranthene, fluorene, Indeno(1,2,3-cd)pyrene, phenanthrene, and pyrene)
Survey Question: Part II.A Question 4 (Question starts on page 5 of survey overview document)Worksheet Title: CO (and Corresponding NOx) CEM Data for Small Gas-Fired* Boilers* or Process Heaters*Who Should Complete this Spreadsheet? Facilities with small gas-fired* boilers or process heaters that have CO CEM data available.

A. Facility Name:B. Combustor ID:C. Control Device Configuration during 30 day period:D. Typical Operating Rate during 30 day period (mmBtu/hr):E.

Were there any operational upsets or other conditions 

you want to explain during this 30-day period?

Fuel 1 (select from dropdown)

Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 (select from dropdown)

Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 (select from dropdown) Fuel 3 Input Rate Fuel 3 Input Rate Units

Fuel 4 (select from dropdown) Fuel 4 Input Rate Fuel 4 Input Rate Units

F. (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below:If other fuel type list below: If other units list below:If other fuel type list below: If other units list below:If other fuel type list below: If other units list below:

G.

Date

(mm/dd/yy)

CO Emissions 

Numerical 

Value CO Emission Unit

Correction (i.e. 3% O2 or other diluent gas)

NOx 

Emissions 

Numerical 

Value NOx Emission Unit

Day 1Day 2Day 3Day 4Day 5Day 6Day 7Day 8Day 9

Day 10Day 11Day 12Day 13Day 14Day 15Day 16Day 17Day 18Day 19Day 20Day 21Day 22Day 23Day 24Day 25Day 26Day 27Day 28Day 29Day 30

H.

Single highest daily average for CO emissions within 

the most recent calendar year of data

I.

Control Device Configuration at maximum CO Daily 

Average:

J.

Operating Rate at maximum CO daily average 

(mmBtu/hr):

Fuel 1 (select from dropdown)

Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 (select from dropdown)

Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 (select from dropdown) Fuel 3 Input Rate Fuel 3 Input Rate Units

Fuel 4 (select from dropdown) Fuel 4 Input Rate Fuel 4 Input Rate Units

K. Fuel Mix at maximum CO daily average: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below:If other fuel type list below: If other units list below:If other fuel type list below: If other units list below:If other fuel type list below: If other units list below:

L.

Were there any operational upsets or other conditions 

you want to explain during this maximum daily average 

emission rate?

Notes:

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

* Indicates a definition of the term is available in the Survey Overview Document

CEM Daily Average Emission Data Points From Most Recent 30-day Operating Period

If the control device configuration, fuel mix, or operating rate for the single highest CO daily average differs from what was described for the 30-day period, please update in cells below if known, otherwise you may leave this section blank:

Typical Fuel Mix During 30 day period: 

(only fuel mixes containing natural gas, propane, liquefie

petroleum gas, and refinery gas are eligible to complete this

worksheet. If you fire other fuels in combination with these

fuels you should complete the spreadsheet corresponding to

survey question II.D.)

Peach shaded cells indicate areas where the user will enter a response

Spreadsheet Instructions:Complete this worksheet for available CEM data for CO at each small gas-fired boiler or process heater. You should provide CEM results for the most recent 30 day operating period, as well as the highest daily average during the most recent calendar year. If available, you should also report corresponding NOx data so that EPA can evaluate the relationship between low NOx requirements and CO emissions. If you have a summary of CEM data that contains the same information in another spreadsheet format, you can submit the CEM data summary in an alternative format.To provide CEM data for more than one boiler, process heater or other combustion device at your facility, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 
Survey Question: Part II.D Question 1 (questions on this worksheet start on page 12 of the survey overview document)

Worksheet Title: Dioxin Furans HAP Emission Test DataWho Should Complete this Spreadsheet?Facility Name:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please

describe units in column H atright.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission DataDioxin/Furans (Select Emission Units)

Indicate basis here by entering TM, TEQ, Other (total mass, toxicequivalent concentration, other) here: 

Other Operating Parameters During Test (These parameters are only required if emission units are provided in units of concentration)

Dry or Wet Basis Wet or DryExhaust Stream %MoistureExhaust Flowrate acfm or dscfmExhaust Temperature C or F

Notes:

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets(e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response* Indicates a definition of the term is available in the Survey Overview Document

(Select Control Configuration)

(you may enter control device as listed in questions II.B.3.a1 or II.B.3.a6, or other (with description), if the control device during the test was not listed in the survey section II.B.3)

Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas fired boilers and process heaters and incinerators) that have Dioxin or Furans Emission Test Data Available.

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should provide the most recent data available for each pollutant at each combustion unit (excluding small gas fired boilers and process heaters that were covered under Part II.A and Incinerators covered under Part IV). EPA encourages you to provide the results of more than one test, in order to allow us to assess intra-unit variability. You may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 
Survey Question: Part II.D Question 1 (questions on this worksheet start on page 12 of the survey overview document)

Worksheet Title: PAH Emission Test DataWho Should Complete this Spreadsheet?Facility Name:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please

describe units in column H atright.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission Data7-PAH* (select emission rate units)15-PAH** (select emission rate units)

Other Operating Parameters During Test (These parameters are only required if emission units are provided in units of concentration)

Dry or Wet Basis Wet or DryExhaust Stream %MoistureExhaust Flowrate acfm or dscfmExhaust Temperature C or F

Notes:

(you may enter control device as listed in questions II.B.3.a1 or II.B.3.a6, or other (with description), if the control device during the test was not listed in the survey section II.B.3)

* Indicates a definition of the term is available in the Survey Overview Document

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets(e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

(Select Control Configuration)

Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas fired boilers and process heaters and incinerators) that have PAH Emission Test Data Available.

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should provide the most recent data available for each pollutant at each combustion unit (excluding small gas fired boilers and process heaters that were covered under Part II.A and Incinerators covered under Part IV). EPA encourages you to provide the results of more than one test, in order to allow us to assess intra-unit variability. You may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 

*7-PAH means: benz(a)anthracene, benzo(a)pyrene, benzo(b)fluoranthene, benzo(k)fluoranthene, chrysene, dibenz(a,h)anthracene, and indeno(1,2,3-cd)pyrene** 15-PAH means acenaphthene, acenaphthylene, anthracene, benzo(a)anthracene, benzo(a)pyrene, benzo(b)fluoranthene, benzo(g,h,i)perylene, benzo(k)fluoranthene, dibenzo(a,h)anthracene, dibenzofuran, fluoranthene, fluorene, Indeno(1,2,3-cd)pyrene, phenanthrene, and pyrene)
Survey Question: Part II.D Question 1 (questions on this worksheet start on page 12 of the survey overview document)

Worksheet Title: Organic HAP and CO Emission Test DataWho Should Complete this Spreadsheet?Facility Name:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify here:(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission Dataacetaldehyde (select emission rate units)benzene (select emission rate units)formaldehyde (select emission rate units)toluene (select emission rate units)xylenes (select emission rate units)CO (select emission rate units)

Other Operating Parameters During Test (These parameters are only required if emission units are provided in units of concentration)

Dry or Wet Basis Wet or Dry% O2 or other diluent gas (necessary only if CO emission data is provided)If other diluent gas, please specify gas in this cellExhaust Stream %MoistureExhaust Flowrate acfm or dscfmExhaust Temperature C or F

Notes:

Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas fired boilers and process heaters and incinerators) that have Organic HAP and CO Emission Test Data Available.

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

* Indicates a definition of the term is available in the Survey Overview Document

(Select Control Configuration)

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

(you may enter control device as listed in questions II.B.3.a1 or II.B.3.a6, or other (with description), if the control device during the test was not listed in the survey section II.B.3)

Spreadsheet Instructions:You should provide the most recent data available for each pollutant at each combustion unit (excluding small gas fired boilers and process heaters that were covered under Part II.A and Incinerators covered under Part IV). EPA encourages you to provide the results of more than one test, in order to allow us to assess intra-unit variability. You may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 
Survey Question:

Worksheet Title:Who Should Complete this Spreadsheet?Facility Name:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please

describe units in column H atright.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission DataHydrogen Chloride (HCl) (select emission rate units)Hydrogen Flouride (HF) (select emission rate units)Chlorine (Cl2) (select emission rate units)

Other Operating Parameters During Test (These parameters are only required if emission units are provided in units of concentration)

Dry or Wet Basis Wet or DryExhaust Stream %MoistureExhaust Flowrate acfm or dscfmExhaust Temperature C or F

Notes:* Indicates a definition of the term is available in the Survey Overview Document

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets(e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

(you may enter control device as listed in questions II.B.3.a1 or II.B.3.a6, or other (with description), if the 

(Select Control Configuration) control device during the test was not listed in the survey section II.B.3)

Inorganic HAP Emission Test DataFacilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas fired boilers and process heaters and incinerators) that have HCl, CL2, or HF Emission Test Data Available.Part II.D Question 1 (questions on this worksheet start on page 12 of the survey overview document)

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should provide the most recent data available for each pollutant at each combustion unit (excluding small gas fired boilers and process heaters that were covered under Part II.A and Incinerators covered under Part IV). EPA encourages you to provide the results of more than one test, in order to allow us to assess intra-unit variability. You may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com.
Survey Question: Part II.D Question 1 (questions on this worksheet start on page 12 of the survey overview document)

Worksheet Title: PM and Metals Emission Test DataWho Should Complete this Spreadsheet?Facility Name:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected pleasedescribe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission DataMercury (Hg) (select emission rate units)Arsenic (As) (select emission rate units)Beryllium (Be) (select emission rate units)Cadmium (Cd) (select emission rate units)Chromium (Cr) (select emission rate units)Lead (Pb) (select emission rate units)Manganese (Mn) (select emission rate units)Nickel (Ni) (select emission rate units)Selenium (Se) (select emission rate units)Particulate Matter (front half) (select emission rate units)Particulate Matter (total, including condensibles) (select emission rate units)Other Operating Parameters During Test (These parameters are only required if emission units are provided in units of concentration)Dry or Wet Basis Wet or DryExhaust Stream %MoistureExhaust Flowrate acfm or dscfmExhaust Temperature C or F

Notes:

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response* Indicates a definition of the term is available in the Survey Overview Document

(Select Control Configuration)

(you may enter control device as listed in questions II.B.3.a1 or II.B.3.a6, or other (with description), if the control device during the test was not listed in the survey section II.B.3)

Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas fired boilers and process heaters and incinerators) that have PM or Metals Emission Test Data Available.

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should provide the most recent data available for each pollutant at each combustion unit (excluding small gas fired boilers and process heaters that were covered under Part II.A and Incinerators covered under Part IV). EPA encourages you to provide the results of more than one test, in order to allow us to assess intra-unit variability. You may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 
Survey Question: Part II.D Question 2 (Questions start on page 13 of the survey overview document)

Worksheet Title: CO CEM Data 

Who Should Complete this 

Spreadsheet?

A. Facility Name:

B. Combustor ID:

C.

Control Device 

Configuration during 30 day 

period (select from 

dropdown): (Select Control Configuration)

D.

Typical Operating Rate 

during 30 day period 

(mmBtu/hr):

E.

Were there any operational 

upsets or other conditions 

you want to explain during 

this 30-day period?

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

F.

Typical Fuel Mix During 30 

day period: (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

G.

Date

(mm/dd/yy)

Emission 

Numerical Value Emission Unit

Correction (i.e. 3% O2 or other 

diluent gas)

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Day 15

Day 16

Day 17

Day 18

Day 19

Day 20

Day 21

Day 22

Day 23

Day 24

Day 25

Day 26

Day 27

Day 28

Day 29

Day 30

H.

Single highest daily average 

emission data point within 

the most recent calendar 

year of data

I.

Control Device 

Configuration at maximum 

daily average: (Select Control Device Configuration)

J.

Operating Rate at maximum 

daily average (mmBtu/hr):

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

K.

Fuel Mix at maximum daily 

average: (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

L.

Were there any operational 

upsets or other conditions 

you want to explain during 

this maximum daily average 

emission rate?

If the control device configuration, fuel mix, or operating rate for the single highest daily average differs from what was described for the 30-day period, 

please update in cells below if known, otherwise you may leave this section blank:

ICR Number 2286.01

OMB Control Number: 2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011

CEM Daily Average Emission Data Points From Most Recent 30-day Operating Period

Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas fired boilers 

and process heaters) that have CO CEM data available.

Spreadsheet Instructions:

Complete this worksheet for available CEM data for CO at each boiler, process heater, or other combustion unit (excluding small gas-fired boiler or process heaters). You should provide CEM results for 

the most recent 30 day operating period, as well as the highest daily average during the most recent calendar year. If you have a summary of CEM data that contains the same information in another 

spreadsheet format, you can submit the CEM data summary in an alternative format. 

To provide CEM data for more than one boiler, process heater or other combustion device at your facility, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the 

appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...

2. In the pop-up window, check the box next to "Create a copy"

3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.

4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets 

to combustionsurvey@erg.com.
Survey Question: Part II.D Question 2 (Questions start on page 13 of the survey overview document)

Worksheet Title: NOx CEM Data 

Who Should Complete this 

Spreadsheet?

A. Facility Name:

B. Combustor ID:

C.

Control Device 

Configuration during 30 day 

period (select from 

dropdown): (Select Control Device Configuration)

D.

Typical Operating Rate 

during 30 day period 

(mmBtu/hr):

E.

Were there any operational 

upsets or other conditions 

you want to explain during 

this 30-day period?

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

F.

Typical Fuel Mix During 30 

day period: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

G.

Date

(mm/dd/yy)

Emission 

Numerical Value Emission Unit

Correction (i.e. 3% O2 or other 

diluent gas)

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Day 15

Day 16

Day 17

Day 18

Day 19

Day 20

Day 21

Day 22

Day 23

Day 24

Day 25

Day 26

Day 27

Day 28

Day 29

Day 30

H.

Single highest daily average 

emission data point within 

the most recent calendar 

year of data

I.

Control Device 

Configuration at maximum 

daily average: (Select Control Device Configuration)

J.

Operating Rate at maximum 

daily average (mmBtu/hr):

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

K.

Fuel Mix at maximum daily 

average: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

L.

Were there any operational 

upsets or other conditions 

you want to explain during 

this maximum daily average 

emission rate?

ICR Number 2286.01

OMB Control Number: 2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011

Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas fired boilers 

and process heaters) that have NOx CEM data available.

CEM Daily Average Emission Data Points From Most Recent 30-day Operating Period

g p g gg y g

was described for the 30-day period, please update in cells below if known, otherwise you may leave this section 

blank:

Spreadsheet Instructions:

Complete this worksheet for available CEM data for NOx at each boiler, process heater, or other combustion unit (excluding small gas-fired boiler or process heaters). You should provide CEM results for 

the most recent 30 day operating period, as well as the highest daily average during the most recent calendar year. If you have a summary of CEM data that contains the same information in another 

spreadsheet format, you can submit the CEM data summary in an alternative format. 

To provide CEM data for more than one boiler, process heater or other combustion device at your facility, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the 

appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...

2. In the pop-up window, check the box next to "Create a copy"

3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.

4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets 

to combustionsurvey@erg com
Survey Question: Part II.D Question 2 (Questions start on page 13 of the survey overview document)

Worksheet Title: SO2 CEM Data 

Who Should Complete this 

Spreadsheet?

A. Facility Name:

B. Combustor ID:

C.

Control Device 

Configuration during 30 day 

period (select from 

dropdown): (Select Control Device Configuration)

D.

Typical Operating Rate 

during 30 day period 

(mmBtu/hr):

E.

Were there any operational 

upsets or other conditions 

you want to explain during 

this 30-day period?

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

F.

Typical Fuel Mix During 30 

day period: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

G.

Date

(mm/dd/yy)

Emission 

Numerical Value Emission Unit

Correction (i.e. 3% O2 or other 

diluent gas)

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Day 15

Day 16

Day 17

Day 18

Day 19

Day 20

Day 21

Day 22

Day 23

Day 24

Day 25

Day 26

Day 27

Day 28

Day 29

Day 30

H.

Single highest daily average 

emission data point within 

the most recent calendar 

year of data

I.

Control Device 

Configuration at maximum 

daily average: (Select Control Device Configuration)

J.

Operating Rate at maximum 

daily average (mmBtu/hr):

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

K.

Fuel Mix at maximum daily 

average: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

L.

Were there any operational 

upsets or other conditions 

you want to explain during 

this maximum daily average 

emission rate?

Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas

fired boilers and process heaters) that have SO2 CEM data available.

ICR Number 2286.01

OMB Control Number: 2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011

CEM Daily Average Emission Data Points From Most Recent 30-day Operating Period

g p g gg y g

was described for the 30-day period, please update in cells below if known, otherwise you may leave this section 

blank:

Spreadsheet Instructions:

Complete this worksheet for available CEM data for SO2 at each boiler, process heater, or other combustion unit (excluding small gas-fired boiler or process heaters). You should provide CEM results for 

the most recent 30 day operating period, as well as the highest daily average during the most recent calendar year. If you have a summary of CEM data that contains the same information in another 

spreadsheet format, you can submit the CEM data summary in an alternative format. 

To provide CEM data for more than one boiler, process heater or other combustion device at your facility, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the 

appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...

2. In the pop-up window, check the box next to "Create a copy"

3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.

4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets 

to combustionsurvey@erg.com.
Survey Question: Part II.D Question 2 (Questions start on page 13 of the survey overview document)

Worksheet Title: Opacity COMS Data 

Who Should Complete this 

Spreadsheet?

A. Facility Name:

B. Combustor ID:

C.

Control Device 

Configuration during 30 day 

period (select from 

dropdown): (Select Control Device Configuration)

D.

Typical Operating Rate 

during 30 day period 

(mmBtu/hr):

E.

Were there any operational 

upsets or other conditions 

you want to explain during 

this 30-day period? If yes, 

please explain briefly.

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

F.

Typical Fuel Mix During 30 

day period: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

G. Submit 6-minute averages for Opacity for the most recent 30-day operating period. You may submit this data in any spreadsheet format so that it can be analyzed.

H.

Single highest six-minute 

average emission data point 

within the most recent 

calendar year of data

I.

Control Device 

Configuration at maximum 6-

minute average: (Select Control Device Configuration)

J.

Operating Rate at maximum 

6-minute average 

(mmBtu/hr):

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

K.

Fuel Mix at maximum 6-

minute average: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

L.

Were there any operational 

upsets or other conditions 

you want to explain during 

this maximum 6-minute 

average emission rate?

Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas

fired boilers and process heaters) that have Opacity COM data available.

ICR Number 2286.01

OMB Control Number: 2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011

g p g gg y g

from what was described for the 30-day period, please update in cells below if known, otherwise you may leave this 

section blank:

Spreadsheet Instructions:

Complete this worksheet for available CEM data for Opacity at each boiler, process heater, or other combustion unit (excluding small gas-fired boiler or process heaters). 

You should provide CEM results for the most recent 30 day operating period, as well as the highest 6-minute average during the most recent calendar year. If you have a 

summary of CEM data that contains the same information in another spreadsheet format, you can submit the CEM data summary in an alternative format. 

To provide CEM data for more than one boiler, process heater or other combustion device at your facility, you may copy and paste this worksheet to a new worksheet wit

this file. Please indicate the appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...

2. In the pop-up window, check the box next to "Create a copy"

3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.

4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all 

other completed spreadsheets to combustionsurvey@erg.com. 
Survey Question: Part II.D Question 2 (Questions start on page 13 of the survey overview document

Worksheet Title: PM CEM Data 

Who Should Complete this 

Spreadsheet?

A. Facility Name:

B. Combustor ID:

C.

Control Device 

Configuration during 30 day 

period (select from 

dropdown):

(Select Control Device 

Configuration)

D.

Typical Operating Rate 

during 30 day period 

(mmBtu/hr):

E.

Were there any operational 

upsets or other conditions 

you want to explain during 

this 30-day period?

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

F.

Typical Fuel Mix During 30 

day period: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

G.

Date

(mm/dd/yy)

Emission 

Numerical Value Emission Unit

Correction (i.e. 3% O2 or other 

diluent gas)

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Day 15

Day 16

Day 17

Day 18

Day 19

Day 20

Day 21

Day 22

Day 23

Day 24

Day 25

Day 26

Day 27

Day 28

Day 29

Day 30

H.

Single highest daily 

average emission data point 

within the most recent 

calendar year of data

I.

Control Device 

Configuration at maximum 

daily average:

(Select Control Device 

Configuration)

J.

Operating Rate at maximum 

daily average (mmBtu/hr):

Fuel 1 

(select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 

(select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 

(select from dropdown)

Fuel 3 Input 

Rate Fuel 3 Input Rate Units

K.

Fuel Mix at maximum daily 

average: (select fuel type) (select fuel input units) (select fuel type) (select fuel input units) (select fuel type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

L.

Were there any operational 

upsets or other conditions 

you want to explain during 

this maximum daily 

average emission rate?

CEM Daily Average Emission Data Points From Most Recent 30-day Operating Period

was described for the 30-day period, please update in cells below if known, otherwise you may leave this section 

blank:

ICR Number 2286.01

OMB Control Number: 2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011 Facilities with Boilers*, Process Heaters*, or Other Combustion Units* (excluding small-gas fired boilers 

and process heaters) that have PM CEM data available.

Spreadsheet Instructions:

Complete this worksheet for available CEM data for PM at each boiler, process heater, or other combustion unit (excluding small gas-fired boiler or process heaters). You should provide CEM results 

for the most recent 30 day operating period, as well as the highest daily average during the most recent calendar year. If you have a summary of CEM data that contains the same information in ano

spreadsheet format, you can submit the CEM data summary in an alternative format. 

To provide CEM data for more than one boiler, process heater or other combustion device at your facility, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the 

appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...

2. In the pop-up window, check the box next to "Create a copy"

3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.

4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name.

 (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.

Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed 

spreadsheets to combustionsurvey@erg com
Survey Question: Part II.D Question 3 (Questions start on page 13 of survey overview document)

Worksheet Title:Who Should Complete this Spreadsheet?Facility Name:Combustor ID:

Parameter Numerical Limit Emission Limit 

Units

Other Emission 

Limit (Please 

Explain)

Fuel Associated 

with Limit

Averaging Time O2 or Other Diluent Gas 

Concentration (% and 

name of gas)

Does Permitted Limit 

reflect the vacated Subpart 

DDDDD in the permit?

Note

(i.e., 30 day rolling average, daily, hourly)

(O2 or other diluent gas concentration is only necessary when reporting a limit for CO)

(Y/N) For all pollutants, provide any 

other information supporting information you think is necessaryabout this limit.

Hydrogen Chloride (HCl) Select SelectMercury (Hg) Select SelectArsenic (As) Select SelectBeryllium (Be) Select SelectCadmium (Cd) Select SelectChromium (Cr) Select SelectLead (Pb) Select SelectManganese (Mn) Select SelectNickel (Ni) Select SelectSelenium (Se) Select SelectParticulate Matter (front half) Select SelectParticulate Matter (total, including condensibles) Select SelectCO Select SelectDioxin/Furans Select Select Indicate basis here by entering TM, TEQ, 

Other (total mass, toxic equivalent concentration, other) here: 

SO2 SelectNOx SelectOpacity Select

Notes:Peach shaded cells indicate areas where the user will enter a response* Indicates a definition of the term is available in the Survey Overview Document

Permitted or Regulatory Emission Limit

Facilities with any non-small gas-fired* boilers, process heaters, or other combustion units* that have permitted or regulatory limits for any of the pollutants listed in the table below.Permitted and Regulatory Limits for non-Small Gas-Fired* Boilers*, Process Heaters* or Other Combustion Units*

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:Copy and paste this worksheet for combustion ID at the facility that has a permitted or regulatory emission limit for any of the pollutants listed below. You may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps: 1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 
Survey Question: Part III (Questions start on page 13 of survey overview document)Worksheet Title: Fuel/Material AnalysisWho Should Complete this Spreadsheet?Facility Name:Fuel/Material (select from list):

(Select Y or N)

Combustor ID:Test Date: (mm/dd/yyyy)

Sample #1 Sample #2 Sample #3 Sample #4 Sample #5 Sample #6 Sample #7 Sample #8 Sample #9 Sample #10 Units Other Units Description

Select appropriate unit from list. If other is selected please describe units in column N

Fuel/Material Sample Date 

(mm/dd/yyyy

Higher Heating Value (Select HHV units)% Moisture %% Ash %% Sulfur %Higher Heating Value (Select HHV units)% Moisture %% Ash %% Sulfur %Chlorine (Cl) (Select Units)Mercury (Hg) (Select Units)Arsenic (As) (Select Units)Beryllium (Be) (Select Units)Cadmium (Cd) (Select Units)Chromium (Cr) (Select Units)Lead (Pb) (Select Units)Manganese (Mn) (Select Units)Nickel (Ni) (Select Units)Selenium (Se) (Select Units)

* Indicates a definition of the term is available in the Survey Overview DocumentPeach shaded cells indicate areas where the user will enter a responseNotes:

ICR Number 2286.01

OMB Control Number: 

2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011

Dry basisParameter TeAs Received

Was fuel analysis was conducted in conjunction with an emission test provided in Section II.D? (Yes or No)

You may provide up to 10 fuel samples for the fuel type selected in cell C20. To provide more than 10 fuel samples you must make a copy of this worksheet. 

Facilities with boilers*, process heaters*, or other combustion units* that combust anything other than natural gas, refinery gas, liquefied petroleum gas or propane. (select) Other Fuel/Material Description:

If yes, please indicate the following parameters:

Spreadsheet Instructions:Provide the results of the most recent fuel/materials analysis for all fuels and materials (excluding natural gas, propane, liquefied petroleum gas, and refinery gas) combusted on-site in boilers, process heaters, or other combustion units. You may submit an analysis done on-site or an analysis provided by the fuel supplier. Use the fuel categories from the list below, when available. Select the ‘other’ fuel description only if the fuel burned in the unit(s) is not on the list. If ‘other’ is selected please provide a brief name for this fuel. Select the most descriptive name as possible. For example, "landfill gas (LFG)" is more useful than "waste-gas"; "bituminous coal" or "anthracite coal" is more useful than "coal". You should provide the most recent data available at for each fuel. EPA encourages you to provide the results of more than fuel analysis, as long as these are representative of fuels/materials still used in the boiler/process heater. To provide a fuel analysis for more than one type of fuel used in a boiler, process heater or other combustion device at your facility, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)If you need further guidance, please see Appendix B1 on the survey overview document for more detailed instructions of how to copy a worksheet.Please indicate the appropriate facility name and combustor ID represented by the test at the top of each worksheet. When complete, e-mail this spreadsheet along with all other completed spreadsheets to combustionsurvey@erg.com. 
APPENDIX D 

2009 TEST PLAN EXCEL TEMPLATES 
Worksheet Title: CO CEMS Data

Who Should Complete this Spreadsheet?

A. Facility ID:

B. Combustor ID:

Fuel 1 (select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 (select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 (select from dropdown)

Fuel 3 Input Rate Fuel 3 Input Rate Units

C.

Typical Fuel Mix During 30 

day period: (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

Date CO Reading O2 level in 

exhaust gas (%)

Heat Input Steam Output CombustionUnit Operations 

Indicator

CO CEMS Operations 

Indicator 

Day/Month/Year

(DD/MM/YYYY)

(ppm) (mmBtu/hr) (1000 lb steam per hour) (note periods of start-up, 

Shutdown, malfunctions, or 

normal operation) 

(note periods where 

monitor was not 

operational) 

DD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYY

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facilities that are reporting CEMS data from a CEMS meeting Performance Specification - 4 Requirements in lieu of conducting a CO emission test.

CO CEM Data for 30-day Period

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter Here

Spreadsheet Instructions:Report the results of CO CEM data for at each boiler or process heater listed in your Section 114 letter. To provide CEM data for more than a 30 day period, or for more than one boiler or process heater, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: NOx CEMS Data

Who Should Complete this Spreadsheet?

A. Facility ID:

B. Combustor ID:

Fuel 1 (select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 (select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 (select from dropdown)

Fuel 3 Input Rate Fuel 3 Input Rate Units

C.

Typical Fuel Mix During 30 

day period: (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

Date NOx Reading O2 level in 

exhaust gas (%)

Heat Input Steam Output CombustionUnit Operations 

Indicator

NOx CEMS Operations 

Indicator 

Day/Month/Year

(DD/MM/YYYY)

(ppm) (mmBtu/hr) (1000 lb steam per hour) (note periods of start-up, 

Shutdown, malfunctions, or 

normal operation) 

(note periods where 

monitor was not 

operational) 

DD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYY

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facilities that are reporting CEMS data from a CEMS meeting Performance Specification - 2 Requirements in lieu of conducting a NOx emission test.

NOX CEM Data for 30-day Period

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter Here

Spreadsheet Instructions:Report the results of NOx CEM data for at each boiler or process heater listed in your Section 114 letter. To provide CEM data for more than a 30 day period, or for more than one boiler or process heater, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: SO2 CEMS Data

Who Should Complete this Spreadsheet?

A. Facility ID:

B. Combustor ID:

Fuel 1 (select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 (select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 (select from dropdown)

Fuel 3 Input Rate Fuel 3 Input Rate Units

C.

Typical Fuel Mix During 30 

day period: (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units)

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below:

Date SO2 Reading O2 level in 

exhaust gas (%)

Heat Input Steam Output CombustionUnit Operations 

Indicator

SO2 CEMS Operations 

Indicator 

Day/Month/Year

(DD/MM/YYYY)

(ppm) (mmBtu/hr) (1000 lb steam per hour) (note periods of start-up, 

Shutdown, malfunctions, or 

normal operation) 

(note periods where 

monitor was not 

operational) 

DD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYYDD/MM/YYYY

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facilities that are reporting CEMS data from a CEMS meeting Performance Specification - 2 Requirements in lieu of conducting a SO2 emission test.

SO2 CEM Data for 30-day Period

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter Here

Spreadsheet Instructions:Report the results of SO2 CEM data for at each boiler or process heater listed in your Section 114 letter. To provide CEM data for more than a 30 day period, or for more than one boiler or process heater, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: CO and HC Monitoring Data 

Who Should Complete this Spreadsheet?

A. Facility ID:B. Combustor ID:

Fuel 1 (select from dropdown) Fuel 1 Input Rate Fuel 1 Input Rate Units

Fuel 2 (select from dropdown) Fuel 2 Input Rate Fuel 2 Input Rate Units

Fuel 3 (select from dropdown)

Fuel 3 Input Rate Fuel 3 Input Rate Units

Fuel 4 (select from dropdown) Fu

C.

Typical Fuel Mix During 30

day period: (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units) (Select Fuel Type) (select fuel input units) (Select Fuel Type) 

If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: If other units list below: If other fuel type list below: 

D.

Time THC Reading CH4 Reading 

(ppm)

Non-CH4 HC Residue CO O2 level in exhaust 

gas (%)

Heat Input Steam Output CombustionUni

t Operations 

Indicator

THC Monitor 

Operations Indicator 

CO CEMS Operations Indicator 

DD: HH:MM (ppm) (ppm) (ppm) Level (mmBtu/hr) (1000 lb steam per hour) (note periods of 

start-up, 

Shutdown, 

malfunctions, or 

normal 

operation) 

(note periods where 

monitor was not 

operational) 

(note periods where monitor was not 

operational) 

DD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MMDD: HH:MM

ICR Number 2286.01OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facilities with Boilers or Process Heaters that were select to conduct 30-day CO/THC variability monitoring.

CO CEM and THC Monitoring Data for 30-day Variability Monitoring

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter Here

Spreadsheet Instructions:Report the results of CO CEM data and THC analyzer data for at each boiler or process heater listed in your Section 114 letter.To provide CEM data for more than a 30 day period, or for more than one boiler or process heater, you may copy and paste this worksheet to a new worksheet within this file. Please indicate the appropriate facility name at the top of each worksheet. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Dioxin Furans HAP Emission Test Data

Who Should Complete this Spreadsheet?

Facility Name:

Combustor ID:

Control Device Configuration: 

Parameter

Sample #1Sample #2Sample #3

Test Average

Units

Units Other 

Description

Test Method Used Test Location Note

Select appropriate unit from 

list. If other is selected please 

describe units in column H at 

right.

Enter the name of the Test Method used.

For Fuel input rates, enter the method used to determine the

fuel input (e.g., F-factor, gas fuel meter, boiler efficiency 

calculation)

Indicate whether the test 

occurred upstream or 

downstream of a control 

device(s)

For all pollutants, provide any other 

information supporting information you 

think is necessary about this test report. 

Sample Date (mm/dd/yyyy)

Required Operating Parameters During Test

Steam Output (1000 lb/hr) (for boilers only) (select heat output units)

Total Heat Input (mmBtu/hr) (select heat input units)

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units)

Dioxin/Furans

2,3,7,8-TCDD ng/dscm @ 7% O2

Other TCDD ng/dscm @ 7% O2

1,2,3,7,8 PeCDD ng/dscm @ 7% O2

Other PeCDD ng/dscm @ 7% O2

1,2,3,4,7,8 HxCDD ng/dscm @ 7% O2

1,2,3,6,7,8 HxCDD ng/dscm @ 7% O2

1,2,3,7,8,9 HxCDD ng/dscm @ 7% O2

Other HxCDD ng/dscm @ 7% O2

1,2,3,4,6,7,8 HpCDD ng/dscm @ 7% O2

Other HpCDD ng/dscm @ 7% O2

1,2,3,4,6,5,7,8 OCDD ng/dscm @ 7% O2

2,3,7,8-TCDF ng/dscm @ 7% O2

Other TCDF ng/dscm @ 7% O2

1,2,3,7,8 PeCDF ng/dscm @ 7% O2

2,3,4,7,8 PeCDF ng/dscm @ 7% O2

Other PeCDF ng/dscm @ 7% O2

1,2,3,4,7,8 HxCDF ng/dscm @ 7% O2

1,2,3,6,7,8 HxCDF ng/dscm @ 7% O2

1,2,3,7,8,9 HxCDF ng/dscm @ 7% O2

2,3,4,6,7,8 HxCDF ng/dscm @ 7% O2

Other HxCDF ng/dscm @ 7% O2

1,2,3,4,6,7,8 HpCDF ng/dscm @ 7% O2

1,2,3,4,7,8,9 HpCDF ng/dscm @ 7% O2

Other HpCDF ng/dscm @ 7% O2

1,2,3,4,6,5,7,8 OCDF ng/dscm @ 7% O2

TOTAL ng/dscm @ 7% O2

Other Operating Parameters During Test

Exhaust Stream %Moisture %

Exhaust Flowrate (select flowrate units)

Exhaust Temperature (select temperature units)

Notes:

Enter numerical value when available. If 

the test results are below detection limit, 

please note the detection limit in brackets 

(e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

* Indicates a definition of the term is available in the Survey Overview Document

Enter all installed air pollution control devices here

Enter the Facility ID from your Section 114 Letter Here

Enter the Combustor ID from your Section 114 Letter Here

Facilities with Boilers or Process Heaters that were selected to test for Dioxins/Furans

ICR Number 2286.03

OMB Control Number: 2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011

Spreadsheet Instructions:

You should report the reults of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a 

worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...

2. In the pop-up window, check the box next to "Create a copy"

3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.

4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Formaldehyde Emission Test Results Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify here:(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)Formaldehyde ppm @ 7% O2

Other Operating Parameters During Test

Exhaust Stream %Moisture %Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter the Facility ID from your Section 114 Letter Here

Facilities with Boilers or Process Heaters that were selected to test for formaldehyde. 

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Enter all installed air pollution control devices hereEnter the Combustor ID from your Section 114 Letter Here

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Spreadsheet Instructions:You should report the reults of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Methane Emission Test Results Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify here:(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)Methane ppm @ 7% O2

Other Operating Parameters During Test

Exhaust Stream %Moisture %Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Facilities with Boilers or Process Heaters that were selected to test for Methane

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices here

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Total HydroCarbons Emission Test Results Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify here:(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)Total Hydrocarbons (THC) ppm @ 7% O2

Other Operating Parameters During Test

Exhaust Stream %Moisture %Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices here

Facilities with Boilers or Process Heaters that were selected to test for THC that do not use Method 25A.

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Carbon Monoxide Alternate Emission Test Results Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify here:(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)Carbon Monoxide (CO) ppm @ 7% O2

Other Operating Parameters During Test

Exhaust Stream %Moisture %Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices here

Facilities on the Boilers, Process Heaters test plan that were selected to test for CO that do not use Method 10 to test for CO

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: NOx Alternate Emission Test Results Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify here:(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)Oxides of Nitrogen (NOx) ppmvd @ 7% O2

Other Operating Parameters During Test

Exhaust Stream %Moisture %Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter NOx concentration value in dry parts per million volume (ppmvd) corrected to 7% oxygen. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices here

Facilities on the Boiler and Process Heater test plan that were selected to test for NOx that do not use Method 7E to test for Nox

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Carbon Monoxide Alternate Emission Test Results Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify here:(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)Sulfur Dioxide (SO2) ppmvd @ 7% O2

Other Operating Parameters During Test

Exhaust Stream %Moisture %Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter the Facility ID from your Section 114 Letter Here

Facilities on the Boiler and Process Heater test plan that were selected to test for SO2 that do not use Method 6C to test for SO2

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Enter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices here

Enter SO2 concentration value in dry parts per million volume (ppmvd) corrected to 7% oxygen. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Selected Metals Emission Test Data

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission DataAntimony (Sb) lb/mmBtuArsenic (As) lb/mmBtuBeryllium (Be) lb/mmBtuCadmium (Cd) lb/mmBtuChromium (Cr) lb/mmBtuCobalt (Co) lb/mmBtuLead (Pb) lb/mmBtuManganese (Mn) lb/mmBtuMercury (Hg) lb/mmBtuNickel (Ni) lb/mmBtuPhosphorus (P) lb/mmBtuSelenium (Se) lb/mmBtuOther Operating Parameters During TestExhaust Stream %Moisture %

Exhaust Stream % CO2 or O2 (sel exhaust O2/CO2 level)Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)Notes:

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices here

Facilities with units on the Boilers, Process Heaters test plan that were selected to test for Metals that do not use Method 29 to test for Metals or Method 101A for Hg

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: HCl Alternate Emission Test Results Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please

describe units in column H atright.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yyyy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission DataHydrogen Chloride (HCl) lb/mmBtuHydrogen Fluoride (HF) lb/mmBtu

Other Operating Parameters During Test

Exhaust Stream %Moisture %

Exhaust Stream % CO2 or O2 (sel exhaust O2/CO2 level)Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets(e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices here

Facilities on the Boilers and Process Heaters test plan that were selected to test for HCl that do not use Method 26A to test for HCl or HF

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Enter the Facility ID from your Section 114 Letter Here

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Filterable PM Emission Test Data

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other 

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission DataParticulate Matter (PM2.5) lb/mmBtuParticulate Matter (PM) filterable lb/mmBtuSolids Data (These parameters are only required from stacks with entrained water droplets)Total Solids from Wet Scrubber Recirculation Liquid mg solids/literTotal Dissolved Solids from Wet Scrubber Recirculation Liquid mg solids/literTotal Suspended Solids from Wet Scrubber Recirculation Liquid mg solids/literScrubber recirculation liquid flow rate liter/minOther Operating Parameters During TestExhaust Stream %Moisture %

Exhaust Stream % CO2 or O2 (sel exhaust O2/CO2 level)Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices hereFacilities with units on the Boilers, Process Heaters test plan that were selected to test for filterable PM or PM2.5 that use do not useMethod 5 or Method 17

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Condensable PM Emission Test Data

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device Configuration: 

Parameter

Sample #1

Sample #2

Sample #3

Test AverageUnits

Units Other

DescriptionTest Method Used Test Location Note

Select appropriate unit from list. If other is selected please describe units in column H at right.

Enter the name of the Test Method used.For Fuel input rates, enter the method used to determine the fuel input (e.g., F-factor, gas fuel meter, boiler efficiency calculation)

Indicate whether the test occurred upstream or downstream of a control device(s)

For all pollutants, provide any other information supporting information you think is necessary about this test report. 

Sample Date (mm/dd/yy)Required Operating Parameters During TestSteam Output (1000 lb/hr) (for boilers only) (select heat output units)Total Heat Input (mmBtu/hr) (select heat input units)(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cell(select fuel type) (select fuel input units)If other fuel type is selected please specify in this cellEmission DataCondensable Particulate Matter lb/mmBtu

Other Operating Parameters During Test

Exhaust Stream %Moisture %

Exhaust Stream % CO2 or O2 (sel exhaust O2/CO2 level)Exhaust Flowrate (select flowrate units)Exhaust Temperature (select temperature units)

Notes:

Facilities with units on the Boilers, Process Heaters test plan that were selected to test for condensable PM

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Enter the Facility ID from your Section 114 Letter HereEnter the Combustor ID from your Section 114 Letter HereEnter all installed air pollution control devices here

Enter numerical value when available. If the test results are below detection limit, please note the detection limit in brackets (e.g., [< 0.010]). 

Select the fuel types used during emission test from the drop down menus and enter their corresponding fuel input rates below. You may enter up to 15 fuel types fired during the test.

Peach shaded cells indicate areas where the user will enter a response

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Fuel/Material AnalysisWho Should Complete this Spreadsheet?Facility ID:Fuel/Material (select from list):

Sample #1 Sample #2 Sample #3 Sample #4 Sample #5 Sample #6 Sample #7 Sample #8 Sample #9 Sample #10 Sample #11 Sample #12 Units Other Units Description

Select appropriate unit from list. If other is selected please describe units in column N

Combustor ID:

Enter the Combustor ID from your Section 114 Letter Here

Enter the Combustor ID from your Section 114 Letter Here

Enter the Combustor ID from your Section 114 Letter Here

Enter the Combustor ID from your Section 114 

Enter the Combustor ID from your Section 114 

Enter the Combustor ID from your Section 114 

Enter the Combustor ID from your Section 114 

Enter the Combustor ID from your Section 114 

Enter the Combustor ID from your Section 114 

Enter the Combustor ID from your Section 114 Letter Here

Enter the Combustor ID from your Section 114 Letter Here

Enter the Combustor ID from your Section 114 Letter Here

What Test was this Fuel Analysis in Conjunction with?

List Corresponding Test Method Here

List Corresponding Test Method Here

List Corresponding Test Method Here

Fuel/Material Sample Date (mm/dd/yyyy)

Basis (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select Basis) (Select HHV units)

Moisture Content %HHV (Select HHV units)Sulfur (S) (Select Units)Nitrogen (N) (Select Units)Chlorine (Cl) (Select Units)Fluorine (F) (Select Units)Mercury (Hg) (Select Units)Antimony (Sb) (Select Units)Arsenic (As) (Select Units)Beryllium (Be) (Select Units)Cadmium (Cd) (Select Units)Chromium (Cr) (Select Units)Cobalt (Co) (Select Units)Lead (Pb) (Select Units)Manganese (Mn) (Select Units)Nickel (Ni) (Select Units)Phosphorus (P) (Select Units)Selenium (Se) (Select Units)

* Indicates a definition of the term is available in the Survey Overview Document

Three Composite Samples During Stack Test Remaining Fuel Samples to Assess Variability

Peach shaded cells indicate areas where the user will enter a responseNotes:

ICR Number 2286.03

OMB Control Number:

2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011

Parameter 

Enter the Facility ID from your Section 114 Letter HereFacilities with boilers and process heaters that were selected to conduct Fuel Analysis(select) Other Fuel/Material Description:

Spreadsheet Instructions:You should report the results of your emission test here. If you submit more than one test for the units at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Boiler and Process Heater 30-Day Process Data Template

Who Should Complete this Spreadsheet?

Facility ID: Enter the Facility ID from your Section 114 Letter Here

Combustor ID: Enter the Combustor ID from your Section 114 Letter Here

Date Total Heat Input

Steam Output 

(for boilers only) Exhaust Flow Exhaust Flow Units

Exhaust 

Temperature

Exhaust 

Oxygen

Exhaust 

Moisture

mm/dd/yy (mmBtu/hr) (1000 lb/hr) acfm or dscfm C or F % %

1 select units select units2 select units select units3 select units select units4 select units select units5 select units select units6 select units select units7 select units select units8 select units select units9 select units select units

10 select units select units11 select units select units12 select units select units13 select units select units14 select units select units15 select units select units16 select units select units17 select units select units18 select units select units19 select units select units20 select units select units21 select units select units22 select units select units23 select units select units24 select units select units25 select units select units26 select units select units27 select units select units28 select units select units29 select units select units30 select units select units

Day

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facilities on the Boiler and Process Heater test plan that were selected to conduct a stack test.

Exhaust 

Temperature

Daily Average Boiler or Process Heater Parameters

Note on 

Process 

Parameters

Spreadsheet Instructions:You should report daily averages for 30 days of unit process data here. The 30 day period shall include the dates of any stack testing and fuel analysis data. The 30 day period can consist of days before and/or after the stack test. You should select the same 30-day period to report all types of required process data and control device monitoring parameters. If you are required to conduct tests at more than one unit at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Boiler and Process Heater 30-Day Fuel Feed Data Template

Who Should Complete this Spreadsheet?

Facility ID:

Combustor ID:

Day

mm/dd/yy

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

(select fuel type) (select fuel input units) (select fuel type) (select fuel 

input units)

(select fuel type) (select fuel input 

units)

If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell If other fuel type is selected please specify in this cell

Fuel Type Fuel Type

Fuel Feed 

Fuel Feed Rate Rate Fuel Type Fuel Feed Rate

Fuel 1 Fuel 2 Fuel 3

1

Date Other Fuel 

Feed Units

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Enter the Facility ID from your Section 114 Letter Here

Enter the Combustor ID from your Section 114 Letter Here

Daily Average Fuel Feed Rates Daily Average Fuel Feed Rates Daily Average Fuel Feed Rates

ICR Number 2286.03

OMB Control Number: 2060-0616

EPA Form No. 5900-122

Expiration Date: 08/31/2011

Facilities on the Boiler and Process Heater test plan that were selected to conduct a stack test.

Fuel Feed Rate Units

Other Fuel 

Feed Units

Fuel Feed 

Rate Units

Other Fuel 

Feed Units

Fuel Feed Rate 

Units

Spreadsheet Instructions:

You should report daily averages for 30 days of fuel feed rate data here. The 30 day period shall include the dates of any stack testing and fuel analysis data. The 30 day period can consist of days before and/or after the stack test. 

You should select the same 30-day period to report all types of required process data and control device monitoring parameters. If you are required to conduct tests at more than one unit at the same facility, you may copy and paste 

this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:

1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...

2. In the pop-up window, check the box next to "Create a copy"

3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.

4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)

When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Boiler and Process Heater 30-Day ESP Control Device Parameter Data Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device: 

Day Date Inlet Voltage

Outlet 

Voltage

Inlet Secondary Current 

(Amperage)

Outlet 

Secondary 

Current 

(Amperage)

mm/dd/yy C or F C or F V V milliamperes (MA)

milliamperes 

(MA)

1 select units select units2 select units select units

3 select units select units

4 select units select units

5 select units select units

6 select units select units

7 select units select units

8 select units select units

9 select units select units

10 select units select units

11 select units select units

12 select units select units

13 select units select units

14 select units select units

15 select units select units

16 select units select units

17 select units select units

18 select units select units

19 select units select units

20 select units select units

21 select units select units

22 select units select units

23 select units select units

24 select units select units

25 select units select units

26 select units select units

27 select units select units

28 select units select units

29 select units select units

30 select units select units

Daily Average ESP Operating Parameters

Note on ESP 

Parameters

(select ESP type)

Facilities on the Boiler and Process Heater test plan that were selected to conduct a stack test and have an ESP installed on the combustion unit.

Enter the Facility ID from your Section 114 Letter Here

ESP Inlet Temperature ESP Outlet Temperature

Enter the Combustor ID from your Section 114 Letter Here

Spreadsheet Instructions:You should report daily averages for 30 days of ESP control device operating parameter data here. The 30 day period shall include the dates of any stack testing and fuel analysis data. The 30 day period can consist of days before and/or after the stack test. You should select the same 30-day period to report all types of required process data and control device monitoring parameters. If you are required to conduct tests at more than one unit at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Boiler and Process Heater 30-Day Fabric Filter Control Device Parameter Data Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device: 

Day Date

Pressure drop

mm/dd/yy C or F C or F

(inches water column)

1 select units select units2 select units select units

3 select units select units

4 select units select units

5 select units select units

6 select units select units

7 select units select units

8 select units select units

9 select units select units

10 select units select units

11 select units select units

12 select units select units

13 select units select units

14 select units select units

15 select units select units

16 select units select units

17 select units select units

18 select units select units

19 select units select units

20 select units select units

21 select units select units

22 select units select units

23 select units select units

24 select units select units

25 select units select units

26 select units select units

27 select units select units

28 select units select units

29 select units select units

30 select units select units

Note on FF Parameters

Fabric Filter Inlet Temperature Fabric Filter Outlet Temperature

Daily Average Fabric Filter Operating Parameters

(select type of fabric filter)

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facilities on the Boiler and Process Heater test plan that were selected to conduct a stack test and have a fabric filter installed on the combustion unit.

Enter the Combustor ID from your Section 114 Letter HereEnter the Facility ID from your Section 114 Letter Here

Spreadsheet Instructions:You should report daily averages for 30 days of Fabric Filter control device operating parameter data here. The 30 day period shall include the dates of any stack testing and fuel analysis data. The 30 day period can consist of days before and/or after the stack test. You should select the same 30-day period to report all types of required process data and control device monitoringparameters. If you are required to conduct tests at more than one unit at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) afterthe name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Boiler and Process Heater 30-Day Sorbent Injection Control Device Parameter Data Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device: Injection Location:

Day Date

Sorbent Injection Rate Sorbent Injection Rate Units

mm/dd/yy C or F C or F gpm or lb/Mmacf

1 select units select units select units2 select units select units select units

3 select units select units select units

4 select units select units select units

5 select units select units select units

6 select units select units select units

7 select units select units select units

8 select units select units select units

9 select units select units select units

10 select units select units select units

11 select units select units select units

12 select units select units select units

13 select units select units select units

14 select units select units select units

15 select units select units select units

16 select units select units select units

17 select units select units select units

18 select units select units select units

19 select units select units select units

20 select units select units select units

21 select units select units select units

22 select units select units select units

23 select units select units select units

24 select units select units select units

25 select units select units select units

26 select units select units select units

27 select units select units select units

28 select units select units select units

29 select units select units select units

30 select units select units select units

Daily Average Sorbent Injection Operating Parameters

Note on Sorbent Inj. Parameters

Other Sorbent 

Inj. Rate Units

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facilities on the Boiler and Process Heater test plan that were selected to conduct a stack test and have sorbent injection installed on the combustion unit.

If Duct Injection, Inlet 

Temperature If Duct Injection, Outlet Temperature

Enter the Combustor ID from your Section 114 Letter HereEnter the Facility ID from your Section 114 Letter Here

(select injection type)

(select injection location)

If other injection type specified, 

enter here:

Spreadsheet Instructions:You should report daily averages for 30 days of sorbent injection control device operating parameter data here. The 30 day period shall include the dates of any stack testing and fuel analysis data. The 30 day period can consist of days before and/or after the stack test. You should select the same 30-day period to report all types of required process data and control device monitoring parameters. You should make a copy of this worksheet for each separate control device or each separate. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Boiler and Process Heater 30-Day Wet Scrubber Control Device Parameter Data Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device: 

Day Date

Pressure drop

Scrubber Liquor pH

Scrubber Liquor Flow Rate

mm/dd/yy C or F C or F

(inches water column)

gallons per minute

1 select units select units2 select units select units

3 select units select units

4 select units select units

5 select units select units

6 select units select units

7 select units select units

8 select units select units

9 select units select units

10 select units select units

11 select units select units

12 select units select units

13 select units select units

14 select units select units

15 select units select units

16 select units select units

17 select units select units

18 select units select units

19 select units select units

20 select units select units

21 select units select units

22 select units select units

23 select units select units

24 select units select units

25 select units select units

26 select units select units

27 select units select units

28 select units select units

29 select units select units

30 select units select units

(select scrubber type)

Daily Average Wet Scrubber Operating Parameters

Note on Wet Scrubber 

Parameters

ICR Number 2286.03OMB Control Number: 2060-0616EPA Form No. 5900-122Expiration Date: 08/31/2011

Facilities on the Boiler and Process Heater test plan that were selected to conduct a stack test and have a wet scrubber installed on the combustion unit.

Wet Scrubber Inlet Temperature Wet Scrubber Outlet Temperature

Enter the Combustor ID from your Section 114 Letter HereEnter the Facility ID from your Section 114 Letter Here

If other scrubber type specified, 

enter here:

Spreadsheet Instructions:You should report daily averages for 30 days of wet scrubber control device operating parameter data here. The 30 day period shall include the dates of any stack testing and fuel analysis data. The 30 day period can consist of days before and/or after the stack test. You should select the same 30-day period to report all types of required process data and control device monitoring parameters. If you are required to conduct tests at more than one unit at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 
Worksheet Title: Boiler and Process Heater 30-Day SCR or SNCR Control Device Parameter Data Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device: Reagent Type

Day Date

Ammonia 

Slip

mm/dd/yy C or F C or F (ppm)

1 select units select units2 select units select units

3 select units select units

4 select units select units

5 select units select units

6 select units select units

7 select units select units

8 select units select units

9 select units select units

10 select units select units

11 select units select units

12 select units select units

13 select units select units

14 select units select units

15 select units select units

16 select units select units

17 select units select units

18 select units select units

19 select units select units

20 select units select units

21 select units select units

22 select units select units

23 select units select units

24 select units select units

25 select units select units

26 select units select units

27 select units select units

28 select units select units

29 select units select units

30 select units select units

Enter the Facility ID from your Section 114 Letter Here

Note on Control Device Parameters

ICR NumOMB CoEPA ForExpiratio

Facilities on the Boiler and Process Heater test plan that were selected to conduct a stack test and have SCR or SNCR control devices installed on the combustion unit.

Control Device Inlet Temperature Control Device Outlet Temperature

Daily Average SCR or SNCR Control Device Operating Parameters

(select reagent)

(select control device)

Enter the Combustor ID from your Section 114 Letter Here

Spreadsheet Instructions:You should report daily averages for 30 days of SCR or SNCR control device operating parameter data here. The 30 day period shall include the dates of any stack testing and fuel analysis data. The 30 day period can consist of days before and/or after the stack test. You should select the same 30-day period to report all types of required process data and control device monitoring parameters. If you are required to conduct tests at more than one unit at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and paste a worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter. 
Worksheet Title: Boiler and Process Heater 30-Day Other Control Device Parameter Data Template

Who Should Complete this Spreadsheet?Facility ID:Combustor ID:Control Device: 

Day Date

mm/dd/yy

12

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

Daily Average Control Device Operating Parameters

Enter Name of Monitored parameter here.

Monitored Parameter #5

Enter Name of Monitored parameter here.

Units for Monitored 

Parameter

Monitored Parameter #3

Enter Name of Monitored parameter here.

Units for 

Monitored 

Parameter

Monitored Parameter #4

Facilities on the Boiler and Process Heater test plan that were selected to conduct a stack test and have control devices other than wet scrubbers, sorbent injection, fabric filters or electprecipitators installed on the combustion unit.

Enter the Facility ID from your Section 114 Letter Here

Enter Name of Monitored parameter here.

Units for Monitored 

Parameter

Monitored Parameter #1 Monitored Parameter #2

Enter Name of Monitored parameter here.

Units for Monitored 

Parameter

Units for Monitored 

Parameter

Enter the Combustor ID from your Section 114 Letter Here

If other control device specified, 

(select control device) enter here:

Spreadsheet Instructions:You should report daily averages for 30 days of any monitored parameters on other control devices as is appropriate for a particular type of control device. If you will report opacity data as a parameter see the opacity dat in this worfor directions. The 30 day period shall include the dates of any stack testing and fuel analysis data. The 30 day period can consist of days before and/or after the stack test. You should select the same 30-day period to report all typrequired process data and control device monitoring parameters. If you are required to conduct tests at more than one unit at the same facility, you may copy and paste this worksheet to a new worksheet within this file. To copy and worksheet, follow these steps:1. On the worksheet you want to copy, select Edit>>Move or Copy Sheet...2. In the pop-up window, check the box next to "Create a copy"3. Under "Before Sheet", select the name of the current sheet you are working in and then Click OK.4. The copied worksheet will be inserted and named according to the current worksheet with a (#) after the name. (The (#) after the name indicates how many copies of the worksheet have been copied and inserted.)When complete, submit this spreadsheet along with all other files for this facility according to the procedures outline in Enclosure 1 to the Section 114 letter.